Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa
Identifieur interne : 000301 ( Istex/Corpus ); précédent : 000300; suivant : 000302Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa
Auteurs : Akinrinola Bankole ; Susheela Singh ; Rubina Hussain ; Gabrielle OestreicherSource :
- American Journal of Men's Health [ 1557-9883 ] ; 2009-03.
English descriptors
- KwdEn :
- Africa bankole, African journal, Alan guttmacher institute, American journal, Bankole, Benin, Benin burkina faso gabon ghana kenya madagascar malawi mali mozambique namibia nigeria rwandab senegal tanzania ugandab zambia zimbabweb panel, Burkina, Burkina faso, Condom, Contraceptive, Disease prevention, Dual protection, Ethiopia, Extramarital, Extramarital partners, Family planning, Family planning purposes, Faso, Female partner, Gabon, Ghana, Guttmacher, Guttmacher institute, Health survey, High level, Kenya, Large majority, Last intercourse, Macro, Madagascar, Malawi, Mali, Mozambique, Multiple partners, Namibia, Nigeria, Past year, Pregnancy, Pregnancy prevention, Pregnancy prevention percentage, Recent surveys, Report condom, Reproductive, Reproductive health, Rwanda, Rwandab, Senegal, Several countries, Sexual intercourse, Sexual partners, Singh, Stis, Study countries, Subsaharan africa, Tanzania, Uganda, Ugandab, Unintended, Unintended pregnancy, Union status, Young people, Young women, Zambia, Zimbabwe, Zimbabweb.
- Teeft :
- Africa bankole, African journal, Alan guttmacher institute, American journal, Bankole, Benin, Benin burkina faso gabon ghana kenya madagascar malawi mali mozambique namibia nigeria rwandab senegal tanzania ugandab zambia zimbabweb panel, Burkina, Burkina faso, Condom, Contraceptive, Disease prevention, Dual protection, Ethiopia, Extramarital, Extramarital partners, Family planning, Family planning purposes, Faso, Female partner, Gabon, Ghana, Guttmacher, Guttmacher institute, Health survey, High level, Kenya, Large majority, Last intercourse, Macro, Madagascar, Malawi, Mali, Mozambique, Multiple partners, Namibia, Nigeria, Past year, Pregnancy, Pregnancy prevention, Pregnancy prevention percentage, Recent surveys, Report condom, Reproductive, Reproductive health, Rwanda, Rwandab, Senegal, Several countries, Sexual intercourse, Sexual partners, Singh, Stis, Study countries, Subsaharan africa, Tanzania, Uganda, Ugandab, Unintended, Unintended pregnancy, Union status, Young people, Young women, Zambia, Zimbabwe, Zimbabweb.
Abstract
The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.
Url:
DOI: 10.1177/1557988308322394
Links to Exploration step
ISTEX:FA90FD55B1E7525196F32358B9CC4CE98DCC6F31Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title><author wicri:is="90%"><name sortKey="Bankole, Akinrinola" sort="Bankole, Akinrinola" uniqKey="Bankole A" first="Akinrinola" last="Bankole">Akinrinola Bankole</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York,</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: abankole@guttmacher.org</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Singh, Susheela" sort="Singh, Susheela" uniqKey="Singh S" first="Susheela" last="Singh">Susheela Singh</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Hussain, Rubina" sort="Hussain, Rubina" uniqKey="Hussain R" first="Rubina" last="Hussain">Rubina Hussain</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Oestreicher, Gabrielle" sort="Oestreicher, Gabrielle" uniqKey="Oestreicher G" first="Gabrielle" last="Oestreicher">Gabrielle Oestreicher</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:FA90FD55B1E7525196F32358B9CC4CE98DCC6F31</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1177/1557988308322394</idno><idno type="url">https://api.istex.fr/document/FA90FD55B1E7525196F32358B9CC4CE98DCC6F31/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000301</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000301</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title><author wicri:is="90%"><name sortKey="Bankole, Akinrinola" sort="Bankole, Akinrinola" uniqKey="Bankole A" first="Akinrinola" last="Bankole">Akinrinola Bankole</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York,</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: abankole@guttmacher.org</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Singh, Susheela" sort="Singh, Susheela" uniqKey="Singh S" first="Susheela" last="Singh">Susheela Singh</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Hussain, Rubina" sort="Hussain, Rubina" uniqKey="Hussain R" first="Rubina" last="Hussain">Rubina Hussain</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Oestreicher, Gabrielle" sort="Oestreicher, Gabrielle" uniqKey="Oestreicher G" first="Gabrielle" last="Oestreicher">Gabrielle Oestreicher</name><affiliation><mods:affiliation>Guttmacher Institute, New York, New York</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">American Journal of Men's Health</title><idno type="ISSN">1557-9883</idno><idno type="eISSN">1557-9891</idno><imprint><publisher>SAGE Publications</publisher><pubPlace>Sage CA: Los Angeles, CA</pubPlace><date type="published" when="2009-03">2009-03</date><biblScope unit="volume">3</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="60">60</biblScope><biblScope unit="page" to="78">78</biblScope></imprint><idno type="ISSN">1557-9883</idno></series><idno type="istex">FA90FD55B1E7525196F32358B9CC4CE98DCC6F31</idno><idno type="DOI">10.1177/1557988308322394</idno><idno type="ArticleID">10.1177_1557988308322394</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1557-9883</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Africa bankole</term><term>African journal</term><term>Alan guttmacher institute</term><term>American journal</term><term>Bankole</term><term>Benin</term><term>Benin burkina faso gabon ghana kenya madagascar malawi mali mozambique namibia nigeria rwandab senegal tanzania ugandab zambia zimbabweb panel</term><term>Burkina</term><term>Burkina faso</term><term>Condom</term><term>Contraceptive</term><term>Disease prevention</term><term>Dual protection</term><term>Ethiopia</term><term>Extramarital</term><term>Extramarital partners</term><term>Family planning</term><term>Family planning purposes</term><term>Faso</term><term>Female partner</term><term>Gabon</term><term>Ghana</term><term>Guttmacher</term><term>Guttmacher institute</term><term>Health survey</term><term>High level</term><term>Kenya</term><term>Large majority</term><term>Last intercourse</term><term>Macro</term><term>Madagascar</term><term>Malawi</term><term>Mali</term><term>Mozambique</term><term>Multiple partners</term><term>Namibia</term><term>Nigeria</term><term>Past year</term><term>Pregnancy</term><term>Pregnancy prevention</term><term>Pregnancy prevention percentage</term><term>Recent surveys</term><term>Report condom</term><term>Reproductive</term><term>Reproductive health</term><term>Rwanda</term><term>Rwandab</term><term>Senegal</term><term>Several countries</term><term>Sexual intercourse</term><term>Sexual partners</term><term>Singh</term><term>Stis</term><term>Study countries</term><term>Subsaharan africa</term><term>Tanzania</term><term>Uganda</term><term>Ugandab</term><term>Unintended</term><term>Unintended pregnancy</term><term>Union status</term><term>Young people</term><term>Young women</term><term>Zambia</term><term>Zimbabwe</term><term>Zimbabweb</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Africa bankole</term><term>African journal</term><term>Alan guttmacher institute</term><term>American journal</term><term>Bankole</term><term>Benin</term><term>Benin burkina faso gabon ghana kenya madagascar malawi mali mozambique namibia nigeria rwandab senegal tanzania ugandab zambia zimbabweb panel</term><term>Burkina</term><term>Burkina faso</term><term>Condom</term><term>Contraceptive</term><term>Disease prevention</term><term>Dual protection</term><term>Ethiopia</term><term>Extramarital</term><term>Extramarital partners</term><term>Family planning</term><term>Family planning purposes</term><term>Faso</term><term>Female partner</term><term>Gabon</term><term>Ghana</term><term>Guttmacher</term><term>Guttmacher institute</term><term>Health survey</term><term>High level</term><term>Kenya</term><term>Large majority</term><term>Last intercourse</term><term>Macro</term><term>Madagascar</term><term>Malawi</term><term>Mali</term><term>Mozambique</term><term>Multiple partners</term><term>Namibia</term><term>Nigeria</term><term>Past year</term><term>Pregnancy</term><term>Pregnancy prevention</term><term>Pregnancy prevention percentage</term><term>Recent surveys</term><term>Report condom</term><term>Reproductive</term><term>Reproductive health</term><term>Rwanda</term><term>Rwandab</term><term>Senegal</term><term>Several countries</term><term>Sexual intercourse</term><term>Sexual partners</term><term>Singh</term><term>Stis</term><term>Study countries</term><term>Subsaharan africa</term><term>Tanzania</term><term>Uganda</term><term>Ugandab</term><term>Unintended</term><term>Unintended pregnancy</term><term>Union status</term><term>Young people</term><term>Young women</term><term>Zambia</term><term>Zimbabwe</term><term>Zimbabweb</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.</div></front></TEI><istex><corpusName>sage</corpusName><keywords><teeft><json:string>condom</json:string><json:string>pregnancy prevention</json:string><json:string>last intercourse</json:string><json:string>burkina</json:string><json:string>faso</json:string><json:string>kenya</json:string><json:string>senegal</json:string><json:string>mozambique</json:string><json:string>gabon</json:string><json:string>namibia</json:string><json:string>uganda</json:string><json:string>malawi</json:string><json:string>unintended pregnancy</json:string><json:string>bankole</json:string><json:string>rwanda</json:string><json:string>benin</json:string><json:string>stis</json:string><json:string>burkina faso</json:string><json:string>zimbabwe</json:string><json:string>ethiopia</json:string><json:string>tanzania</json:string><json:string>zambia</json:string><json:string>dual protection</json:string><json:string>disease prevention</json:string><json:string>madagascar</json:string><json:string>sexual intercourse</json:string><json:string>nigeria</json:string><json:string>pregnancy</json:string><json:string>rwandab</json:string><json:string>zimbabweb</json:string><json:string>reproductive health</json:string><json:string>ugandab</json:string><json:string>mali</json:string><json:string>macro</json:string><json:string>singh</json:string><json:string>study countries</json:string><json:string>guttmacher</json:string><json:string>past year</json:string><json:string>american journal</json:string><json:string>multiple partners</json:string><json:string>sexual partners</json:string><json:string>reproductive</json:string><json:string>unintended</json:string><json:string>recent surveys</json:string><json:string>africa bankole</json:string><json:string>young people</json:string><json:string>extramarital</json:string><json:string>pregnancy prevention percentage</json:string><json:string>female partner</json:string><json:string>report condom</json:string><json:string>health survey</json:string><json:string>union status</json:string><json:string>alan guttmacher institute</json:string><json:string>extramarital partners</json:string><json:string>ghana</json:string><json:string>large majority</json:string><json:string>family planning purposes</json:string><json:string>african journal</json:string><json:string>guttmacher institute</json:string><json:string>young women</json:string><json:string>high level</json:string><json:string>family planning</json:string><json:string>subsaharan africa</json:string><json:string>benin burkina faso gabon ghana kenya madagascar malawi mali mozambique namibia nigeria rwandab senegal tanzania ugandab zambia zimbabweb panel</json:string><json:string>several countries</json:string><json:string>contraceptive</json:string><json:string>intercourse</json:string><json:string>casual partner</json:string><json:string>effective protection</json:string><json:string>months percentage</json:string><json:string>other stis</json:string><json:string>rapid spread</json:string><json:string>sexual partner</json:string><json:string>higher education</json:string><json:string>better access</json:string><json:string>active people</json:string><json:string>educational attainment</json:string><json:string>more partners</json:string><json:string>secondary education</json:string><json:string>pregnancy protection</json:string><json:string>high risk</json:string></teeft></keywords><author><json:item><name>Akinrinola Bankole PhD</name><affiliations><json:string>Guttmacher Institute, New York, New York,</json:string><json:string>E-mail: abankole@guttmacher.org</json:string></affiliations></json:item><json:item><name>Susheela Singh PhD</name><affiliations><json:string>Guttmacher Institute, New York, New York</json:string></affiliations></json:item><json:item><name>Rubina Hussain MPH</name><affiliations><json:string>Guttmacher Institute, New York, New York</json:string></affiliations></json:item><json:item><name>Gabrielle Oestreicher MS</name><affiliations><json:string>Guttmacher Institute, New York, New York</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>condoms</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>young men</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sexually transmitted infections</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>HIV</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>unintended pregnancy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Sub-Saharan Africa</value></json:item></subject><articleId><json:string>10.1177_1557988308322394</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.</abstract><qualityIndicators><score>6.812</score><pdfVersion>1.3</pdfVersion><pdfPageSize>585 x 783 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>941</abstractCharCount><pdfWordCount>9146</pdfWordCount><pdfCharCount>59712</pdfCharCount><pdfPageCount>19</pdfPageCount><abstractWordCount>151</abstractWordCount></qualityIndicators><title>Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title><genre><json:string>research-article</json:string></genre><host><title>American Journal of Men's Health</title><language><json:string>unknown</json:string></language><issn><json:string>1557-9883</json:string></issn><eissn><json:string>1557-9891</json:string></eissn><publisherId><json:string>JMH</json:string></publisherId><volume>3</volume><issue>1</issue><pages><first>60</first><last>78</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>social science</json:string><json:string>public, environmental & occupational health</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>public health & health services</json:string><json:string>public health</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string><json:string>pathologie infectieuse</json:string></inist></categories><publicationDate>2009</publicationDate><copyrightDate>2009</copyrightDate><doi><json:string>10.1177/1557988308322394</json:string></doi><id>FA90FD55B1E7525196F32358B9CC4CE98DCC6F31</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/FA90FD55B1E7525196F32358B9CC4CE98DCC6F31/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/FA90FD55B1E7525196F32358B9CC4CE98DCC6F31/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/FA90FD55B1E7525196F32358B9CC4CE98DCC6F31/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>SAGE Publications</publisher><pubPlace>Sage CA: Los Angeles, CA</pubPlace><availability><p>SAGE</p></availability><date>2009</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title><author xml:id="author-1"><persName><forename type="first">Akinrinola</forename><surname>Bankole</surname></persName><roleName type="degree">PhD</roleName><email>abankole@guttmacher.org</email><affiliation>Guttmacher Institute, New York, New York,</affiliation></author><author xml:id="author-2"><persName><forename type="first">Susheela</forename><surname>Singh</surname></persName><roleName type="degree">PhD</roleName><affiliation>Guttmacher Institute, New York, New York</affiliation></author><author xml:id="author-3"><persName><forename type="first">Rubina</forename><surname>Hussain</surname></persName><roleName type="degree">MPH</roleName><affiliation>Guttmacher Institute, New York, New York</affiliation></author><author xml:id="author-4"><persName><forename type="first">Gabrielle</forename><surname>Oestreicher</surname></persName><roleName type="degree">MS</roleName><affiliation>Guttmacher Institute, New York, New York</affiliation></author></analytic><monogr><title level="j">American Journal of Men's Health</title><idno type="pISSN">1557-9883</idno><idno type="eISSN">1557-9891</idno><imprint><publisher>SAGE Publications</publisher><pubPlace>Sage CA: Los Angeles, CA</pubPlace><date type="published" when="2009-03"></date><biblScope unit="volume">3</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="60">60</biblScope><biblScope unit="page" to="78">78</biblScope></imprint></monogr><idno type="istex">FA90FD55B1E7525196F32358B9CC4CE98DCC6F31</idno><idno type="DOI">10.1177/1557988308322394</idno><idno type="ArticleID">10.1177_1557988308322394</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>condoms</term></item><item><term>young men</term></item><item><term>sexually transmitted infections</term></item><item><term>HIV</term></item><item><term>unintended pregnancy</term></item><item><term>Sub-Saharan Africa</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-03">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/FA90FD55B1E7525196F32358B9CC4CE98DCC6F31/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spjmh</journal-id><journal-id journal-id-type="publisher-id">JMH</journal-id><journal-title>American Journal of Men's Health</journal-title><issn pub-type="ppub">1557-9883</issn><publisher>
<publisher-name>SAGE Publications</publisher-name>
<publisher-loc>Sage CA: Los Angeles, CA</publisher-loc>
</publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/1557988308322394</article-id><article-id pub-id-type="publisher-id">10.1177_1557988308322394</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</article-title></title-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bankole</surname><given-names>Akinrinola</given-names></name><degrees>PhD</degrees><aff>Guttmacher Institute, New York, New York, <email xlink:type="simple">abankole@guttmacher.org</email></aff></contrib></contrib-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Singh</surname><given-names>Susheela</given-names></name><degrees>PhD</degrees><aff>Guttmacher Institute, New York, New York</aff></contrib></contrib-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hussain</surname><given-names>Rubina</given-names></name><degrees>MPH</degrees><aff>Guttmacher Institute, New York, New York</aff></contrib></contrib-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Oestreicher</surname><given-names>Gabrielle</given-names></name><degrees>MS</degrees><aff>Guttmacher Institute, New York, New York</aff></contrib></contrib-group>
<pub-date pub-type="ppub"><month>03</month><year>2009</year></pub-date><volume>3</volume><issue>1</issue><fpage>60</fpage><lpage>78</lpage><abstract><p>The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.</p></abstract><kwd-group><kwd>condoms</kwd>
<kwd>young men</kwd>
<kwd>sexually transmitted infections</kwd>
<kwd>HIV</kwd>
<kwd>unintended pregnancy</kwd>
<kwd>Sub-Saharan Africa</kwd></kwd-group><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>60 Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa SAGE Publications, Inc.200910.1177/1557988308322394 AkinrinolaBankole PhD Guttmacher Institute, New York, New York, abankole@guttmacher.org SusheelaSingh PhD Guttmacher Institute, New York, New York RubinaHussain MPH Guttmacher Institute, New York, New York GabrielleOestreicher MS Guttmacher Institute, New York, New York The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries. condoms young men sexually transmitted infections HIV unintended pregnancy Sub-Saharan Africa Introduction The high pregnancy rates and associated high levels of unintended births, unsafe abortion, maternal mor- bidity, and mortality in Sub-Saharan Africa were the original concerns for the low level of contraceptive use in the region. However, since the emergence of HIV/AIDS in the 1980s and its rapid spread in Sub- Saharan Africa, the need for contraception that can protect men and women against both unintended pregnancy and sexually transmitted infections (STIs), including HIV and AIDS is now an additional reason for concern. The statistics on the impact of the HIV and AIDS epidemic alone portray the urgency of the matter. Almost 30 million people are estimated to be living with HIV and AIDS in Sub-Saharan Africa. The rapid spread of the epidemic in the region has led to the loss of millions of lives and left many millions of children without parents. It is evident that finding effective means of stemming the spread of this infec- tion is a matter needing immediate attention. Apart from HIV and AIDS, other STIs, such as gonorrhea, syphilis, and chlamydia are common in the region. Given this background, the need to promote the use of the condom for disease prevention in Sub-Saharan Africa has never been more urgent. Currently, for people who are sexually active, the latex condom is the only method that offers effective protection simultaneously against HIV (and some other STIs) and unintended pregnancy. Consequently, a series of policy and program efforts to promote con- dom use have been initiated worldwide since the out- break of the HIV epidemic. Despite these extensive efforts and despite the high level of risk of infection and unintended pregnancy, the large majority of sexually active people in Sub-Saharan Africa are not using the condom (Bankole, Singh, Woog, & Wulf, 2003). This is particularly disturbing given that many studies con- tinue to confirm its efficacy when used correctly and continuously (Davis & Weller, 1999; Hearst & Chen, 2004; Trussell, 2004). As a group, young people are particularly vulner- able to HIV infection because of social, cultural, From the Guttmacher Institute, New York, New York. Address correspondence to: Akinrinola Bankole, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038; e-mail: abankole@guttmacher.org. 61 physiological, and economic factors (Ankrah, 1996; Hersh, Lane, & Feijoo, 1998). About 1 in 3 people liv- ing with HIV and AIDS in Sub-Saharan Africa are young people aged 15 to 24, and half of all new cases of HIV infection are among young people (Kiragu, 2001; UNAIDS & WHO, 2002). Unless the spread of the epidemic is curtailed in the near future, the con- sequences for the youth and the entire population of the region will be devastating. Clearly, the loss of large numbers of young people who are in their productive years poses a great threat to economic and social con- ditions and to the political stability of many countries in the region (Summers, Kates, & Murphy, 2002). Similarly, young men in Sub-Saharan Africa, the large majority of whom are unmarried, are at risk of impreg- nating women unintentionally. Most men in the region become sexually experienced in their teenage years, but the large majority of these sexually active young men do not get married until their mid- to late 20s (Bankole et al., 2003). It is estimated that on average, men spend about 6 years between the age of becom- ing sexually experienced and entering marriage (Alan Guttmacher Institute, 2003). Until recently there has been little or no data that aid in understanding the use of the condom for protection against STIs, as opposed to use for preg- nancy protection, in Sub-Saharan Africa. In the past decade, national surveys that include young men have been increasingly implemented in Sub-Saharan Africa, and for 18 countries in this region, they have collected comparative data on condom use that per- mit measurement of the proportion using the con- dom only for pregnancy protection, only for STI protection, or for both reasons. Results indicate that questions used in recent surveys obtain a much more comprehensive measure of condom use than prior questions that asked only about use for preg- nancy protection. For example, in Ghana in 1998, 15% of sexually experienced men aged 15 to 59 said they used the condom at last intercourse, and about half of this group (7%) said they used the method for reason(s) other than family planning (Ghana Statis- tical Services & Macro International Inc., 1999). In the 2003 survey, 18% of Ghanaian men said they used a condom at last intercourse. However, the rea- son for use was more clearly defined: 9% for preg- nancy prevention, 2% for STI protection, and 7% for both purposes (Ghana Statistical Services, Noguchi Memorial Institute for Medical Research [NMIMR], & ORC Macro, 2004). Findings from existing studies indicate that although overall use of the condom is moderate or low in Sub-Saharan Africa, use of the method varies, depending on men's characteristics. For example, condom use is much higher among younger men than among their older counterparts. In Ghana, whereas 13% of all men reported current use of the condom in 2003, 26% of men aged 20 to 24 are cur- rently using the method compared with only 7% of men aged 40 to 44 (Ghana Statistical Services et al., 2004). Condom use also tends to be more prevalent among sexually active unmarried men compared with their married counterparts. For instance, in Kenya, 48% of men in this category reported current condom use in 2003 compared with 4% of married men (Central Bureau of Statistics [Kenya], Ministry of Health [Kenya], & ORC Macro, 2004). This study analyzes recent data for 18 countries to answer the following questions: • What proportion of sexually active men aged 15 to 29 are using the condom for any reason? • What factors are associated with condom use among these men? • What proportions of these men are using the con- dom for STIs/HIV prevention, for pregnancy pre- vention, and for both purposes. • How do reasons for using the condom vary by young men's sociodemographic characteristics? By analyzing differences and similarities across the 18 countries with the relevant information, com- parative analysis can yield valuable insights and per- tinent information necessary for controlling the spread of STIs/HIV and reducing the high level of unintended pregnancy in the region. Presenting comparable evidence affords countries the opportu- nity to compare their situation with others. It can also serve as a motivation for countries to collabo- rate with or seek assistance from each other when they find that they are facing similar situations or when one finds that another has achieved a greater success than it has in some desirable areas, such as increase in condom use and reduction in exposure to the risk of STIs/HIV and unintended pregnancy. Data Source and Methodology Data from the Demographic and Health Surveys (DHSs) among men of reproductive age, conducted by Macro International between 1999 and 2006 in 18 Sub-Saharan countries were used for this study. The countries were selected on the basis of data availability, but their geographic spread covers the various subregions of Sub-Saharan Africa. All coun- tries included here surveyed men aged 15 to 29 and 62 obtained comparable data on the level of condom use and on reasons for condom use. This study includes a broader age range than some studies of young men (often the age range 15 to 24 is applied in studies of youth) because men experience many of the same risks and needs at ages 25 to 29 as at ages 20 to 24, and in addition, for prac- tical reasons, to ensure a sufficiently large sample of married and unmarried young men in all 18 study countries. The sample size (unweighted number of interviewed men 15 to 29) ranges from 1,037 in Gabon to 4,448 in Zimbabwe (see Table 1). The article focuses on young men aged 15 to 29 because they are a population group that is at very high risk of STIs/HIV and a group that contributes significantly to the high rate of unintended preg- nancy among young women but one whose situation has been relatively poorly documented until recently. Young women are a group at very high risk and are even more severely affected by the epidemic—HIV prevalence rates are 2 times or more as high among young women as among young men—from conse- quences of unintended pregnancy and births, such as unsafe abortion and school dropout (Joint UN Programme on HIV/AIDS, 2000). However, to better understand condom use, this article focuses on young men given their important role in determining use of the condom and their more accurate reporting of use of this method. The increased understanding of the situation of this group vis-à-vis HIV and unin- tended pregnancy risks and prevention should con- tribute to an improved awareness of young men's needs in the areas of information and health care services and to informed formulation of policies and programs to protect the sexual and reproductive health of both young men and young women. Unlike the previous waves of DHS surveys, which in most countries obtained use of the condom for fam- ily planning purposes only, the recent series of DHS surveys, as part of the efforts to provide information that is relevant for understanding risk for HIV/STIs and extent of prevention, have obtained information on use of the condom for any reason (i.e., for either family planning purposes or for protection against STIs). For all the 18 countries included in the article, the surveys asked about use of the condom at last sex- ual intercourse, without any qualification about the reason for use.1 Respondents who reported condom use at last intercourse were asked “What was the main reason you used a condom on that occasion?”2 These questions provide the measures that are the focus of analysis for this article—use of the condom at last sex in the last 12 months and reasons for condom use. For these 18 countries, the proportions of sexu- ally active young men who used the condom at last intercourse for either or both purposes are presented. In Ethiopia, Rwanda, Uganda, and Zimbabwe, infor- mation on reason for condom use at last intercourse was not available in the most recent surveys (2005-2006). In these four countries, analysis of this information was based on information from the penultimate DHS surveys (1999-2001). Data were obtained on men's sexual behavior and the number of sexual partners during the 12-month period prior to the survey, for married and unmarried men. In this article, “married” is defined to include all forms of marriage or union (sanctioned by law or cus- tom, or living together [cohabiting or consensual union]; monogamous or polygynous). Unmarried men were asked about the number of sexual partners they had had during the past year, and married men were asked about the number of sexual partners other than their spouse (or in the case of men in polygynous unions, other than their wives). A key measure of risk for STIs/HIV infection was having two or more partners in a relatively short period of time, typically defined to be 1 year. For married men, this measure was defined to be having one or more extramarital partners in the past year (i.e., sex with at least one partner who was not a spouse); for unmarried men, the measure was more straightforward and was equivalent simply to having reported two or more sexual partners in the past year. These DHS surveys obtained information on a number of characteristics of the respondents, includ- ing age, union status, residence, educational attain- ment, and exposure to the radio and television. The measures of exposure to radio and television are pre- sented as dichotomous variables: The one on expo- sure for radio takes on a value of 1 if a man listened to the radio daily and 0 otherwise, whereas the other, on exposure to television, is assigned the value of 1 if a man watched television at least once a week and 0 otherwise. These background or antecedent variables, as well as the more proximate variable, number of partners, are examined to see how they affect reasons for using the method. In addition to bivariate analyses of condom use by selected subgroups, the net associ- ations of the explanatory variables on reason for using 1. The two questions that elicit this information are “When was the last time you had sexual intercourse?” and “The last time you had sexual intercourse, was a condom used?” 2. The response categories provided were “own concern to prevent STD/HIV,” “own concern to prevent pregnancy,” “own concern to prevent both STD/HIV and pregnancy,” “did not trust partner/feel partner has other partners,” “partner insisted,” and “don't know.” 63 C/5 _CJ CJJ Ta o \0 ""0 (50 O "9 o (j) _c (j) “not in bJJ (j) (j) S-i o (j) ¡: 3 -a 64 the condom at last intercourse were examined. To determine the predictors of reasons for using the con- dom at last intercourse, a multinomial logit model was estimated because the dependent variable has four categories: did not use, used for STI prevention only, used for pregnancy prevention only, and used for both purposes. Multivariate analysis results are presented for 17 countries: Ethiopia is omitted because of inadequate number of cases for the four reasons for use of the condom. All estimates presented in this article are weighted national estimates (the numbers of cases on which proportions are based are indicated in the appendix). For the regression results, significance tests were conducted to ascertain the statistical sig- nificance of the net effects of covariates of condom use at last intercourse. Significance is indicated at the .01, .05, and .10 levels, using two-tailed tests. The standard errors of the estimates were computed using the “svy” procedure in Stata to account for the com- plex nature of the sampling method used in selecting respondents for the surveys (Stata Corp, 2003). One limitation of the data is that men tend to overstate their sexual activity and the number of sex- ual partners they have had (Alan Guttmacher Institute, 2003). In addition, they may overreport con- dom use to seem more socially responsible (Salem, 2004). However, men have been consistent with their responses on these issues over time and across studies to suggest that their responses are reasonably close to the actual situation. The multivariate model does not necessarily imply causal relationship, particularly because the temporal order of some of the explanatory variables vis-à-vis the dependent variable is uncertain. Results Background Characteristics The context of men's lives is germane to under- standing their attitudes and perceptions as well as their behaviors regarding their sexual and reproductive health. For example, urban residents are likely to have better access to condoms and higher education is likely to be linked to better knowledge of the need and ways (including condom use) to prevent STIs/HIV and unintended pregnancy. Higher education is likely to be associated with higher income and, thus, better access to condoms. Being in union is associ- ated with a reduced likelihood of risky sexual behav- ior as well as a lower likelihood of using the condom. Although exposure to mass media is in some sense a behavioral characteristic, it is to some extent indica- tive of social economic status: for these reasons, and because of its positive association with access to sexual and reproductive health information and services, it is included in this study. Two variables—whether or not young men listened to the radio and television frequently—are considered as measures of media exposure. In Table 1, we present the distribution of men aged 15 to 29 according to each of the characteristics that are included in the explanatory analyses of men's use of the condom and reasons for using the condom. As expected, given that the older age group spans 10 years (20-29) compared with the 5-year span of the adoles- cent group (15-19), a larger proportion of the study population of men aged 15 to 29 are in their 20s— ranging from 53% in Burkina Faso to 66% in Madagascar (Table 1, column 4). In 16 countries, the majority of men aged 15 to 29 live in rural areas: two thirds or more of men live in rural areas in 7 of the 18 countries. In Gabon and Rwanda, 82% to 83% of men aged 15 to 29 live in urban areas (Table 1, column 5). Countries show a wide range of educational attain- ment: in several countries, less than 25% of young men have some secondary schooling or higher, and in a few (Gabon, Ghana, Nigeria, and Zimbabwe), 64% to 72% have this level of education (Table 1, column 8). Reflecting the fact that in most countries in the region men marry in their mid- to late 20s, less than half of 15 to 29-year-old men are married or in a union in the vast majority of countries (Table 1, column 10). In six coun- tries, however (Ethiopia, Madagascar, Malawi, Rwanda, Senegal, and Uganda), 50% or more young men aged 15 to 29 are in union, whereas in seven study countries, less than 25% are in union (Burkina Faso, Gabon, Ghana, Kenya, Mali, Namibia, and Nigeria). At least half of the young men in the 15 to 29 age group reported listening to the radio daily in 13 out of the 18 countries (Table 1, column 11). Fewer young men had access to the television compared with the radio. The proportion who reported watching television at least once a week is 50% or more only in four countries (Gabon, Ghana, Nigeria, and Rwanda). This propor- tion is very low (less than 15%) in Ethiopia and Uganda (Table 1, column 12). Sexual Behavior Proportion who ever had sexual intercourse. Although only a tiny proportion (0.2%-6%) of men aged 15 to 19 are married or in a union, a substantial propor- tion have had sexual experience. Among those 65 who are not in union, one third or more have had intercourse in 11 of the 18 countries, and at least half have done so in 7 countries (Table 2, column 3). By age 20 to 29, the proportion of men who are in union has increased, but the majority of them are still unmarried in 13 countries (Table 2, column 6). The proportion in union in this age bracket ranges from 20% in Namibia to 63% in Mozambique. The majority of unmarried men 20 to 29 years old in all countries are sexually experienced with the exception of Ethiopia, where only 30% have ever had sex. Proportion sexually active in recent period. Although it is safe to assume that married men are sexually active, the same cannot be said of unmarried men who have ever had sex, especially the younger ones. It is not uncommon for adolescent men to have sex only spo- radically after the first experience (Singh & Bankole, 2001). A measure of recent sexual activity is, there- fore, more relevant to the assessment of information and service needs than that of ever having had inter- course. With the assumption that men who are in union are currently sexually active, measures of recent sexual activity only for men who are not in union are presented. Both in terms of the proportion of men who had sex in the last 12 months and in the last 3 months, the proportion of 15- to 19-year-old men who are sex- ually active varies greatly across countries and is rela- tively low, compared with that of unmarried men in their 20s (Table 2, columns 3 and 4 vs. 7 and 8). For example, the proportion of 15- to 19-year-old unmar- ried men who had sexual intercourse in the 12 months prior to the survey ranges from 4% in Ethiopia to 67% in Gabon (Table 2, column 4). However, among men aged 20 to 29 not in union, a majority of them (53%- 90%) have had sexual intercourse in 13 of the 18 countries in the past 12 months, and at least 40% have had sex in the 3 months prior to the survey in 14 coun- tries (Table 2, Column 9). Number of sexual partners. Although there is great variation across countries in terms of sexual behavior, some men in all societies had two or more sexual partners in the recent 1-year period. An unknown proportion of men who had two or more partners in the past year had some overlap in their sexual part- nerships. Having a number of sexual partners close together is believed to be risky because it tends to promote the transmission of STIs, especially when effective protection is not used correctly and in every act of intercourse. Furthermore, it is evident from other studies that some of these multiple partners are those who themselves engage in sex with other men, such as commercial sex workers (Messersmith, Kane, Odebiyi, & Adewuyi, 2000). For men aged 15 to 29, the proportion who had two or more sexual partners in the 12 months before the survey are presented: This measure is based on the number of sexual partners for men who are not in union and the number of extramarital partners for men in union. Having multiple sexual partners within a 1- year period is common among sexually experienced young men who are not in union: 20% or more have multiple partners in 10 of the 18 countries. The pro- portion that have 2 or more sexual partners ranges from about 2% in Rwanda to about 39% in Mozambique (Table 2, column 10). Among men who are in union, the proportion with one or more extramarital part- ners in the last 12 months is relatively low in Ethiopia, Malawi, and Rwanda (2%-9%). However, in Benin, Gabon, Mozambique, Namibia, Senegal, and Tanzania, more than 30% of men in union have had recent extramarital relations (Table 2, column 11). Given this background of a high level of sexual activity and multiple partnerships, it is important to examine how men protect themselves against unin- tended pregnancy and STIs. The following sections of this article look at men's use of the condom at last intercourse and reasons for using this method. Knowledge and Use of Condoms at Last Intercourse Knowledge of the condom. Many studies have reported that most men of all ages have heard of modern methods of contraception, including the condom (Curtis & Neitzel, 1996). As the saying goes, “Knowledge is power.” First and foremost, whether or not an individual uses the condom depends on his or her knowledge about the method. Therefore, as a background to understanding condom use among young men, the level of knowledge is presented for men aged 15 to 29. This measure is based on a ques- tion that captures awareness of the method but does not necessarily measure knowledge of how to use a condom correctly. Awareness of the condom is very high among young men (Table 3, column 2). At least 90% reported had heard of the method in 12 coun- tries, and at least 80% had done so in 5 countries. The lowest proportion of men aged 15 to 29 with knowledge of the condom is 73%, in Madagascar. Use of condoms at last intercourse. Because of fre- quent discontinuation or switching of methods among couples, far fewer men tend to be using any method at a particular time or period than have ever 66 67 Table 3. Knowledge and Use of Condoms Among Men 15 to 29, by Country, According to Age and Union Status a. “In union” refers to men who are legally married or are living together with a female partner, whereas “not in union” refers to men who were formerly married or never married men. used the method. The condom is not an exception, as data on use of the condom at last intercourse in the 12 months prior to the survey shows (Table 3). This measure gives a more realistic picture of pro- tection that the condom provides at a given point in time than does ever use of the method. The proportion of young men aged 15 to 29 who were sexually active in the past year who used the condom at last intercourse in the last 12 months is quite low in a few countries: It ranges from 6% to 13% in Madagascar, Ethiopia, and Rwanda (Table 3, column 3). However, it is moderate in the majority of the study countries (20%-46%) and quite high in a few countries: Burkina Faso (56%) and Namibia (74%) (Table 3, column 3). Differences in proportions using the condom at last intercourse across subgroups are generally large, and they are in the direction that might be expected. Adolescent men are more likely to be using the method (by at least 5 percentage points, but often much more) than men in their 20s in 12 out of the 18 study countries (Table 3, columns 4 and 5). In all countries, with the exception of Benin, Gabon, and Mali, young men who are not in union are much more likely to have used the condom at last inter- course than their counterparts who are in union (Table 3, Columns 6 and 7). Reasons Why Young Men Use the Condom Condoms provide dual protection against HIV (and some other STIs) and unintended pregnancy, when used correctly and consistently. For program purposes it is therefore useful to know the reason why people use the method. Stated reasons for using the method may help program managers better understand the nature of the sexual and reproductive health needs of people and how to meet such needs. For example, if people indicate that they use the method for disease prevention more than for pregnancy prevention, this could help ensure that public education efforts pay adequate attention to this reason, and it could lead providers to find ways to make the condom more available to those who are at risk of contracting STIs. In this section, we examine the reasons that young men gave for using the condom at last sex in 18 coun- tries for which relevant data are available. Table 4 presents the percentage distribution of sexually active men in the 15 to 29 age group accord- ing to reason for using the method. The analysis excludes a few men who did not indicate the reason or reported that they used the condom at last intercourse because the partner insisted or because they did not trust the partner. In 10 out of the 18 countries, a 68 higher percentage of young men aged 15 to 29 report condom use for disease prevention only rather than for pregnancy prevention only (Table 4, columns 4 and 5). The difference is particularly high in Namibia, where 36% of sexually active men use condoms for disease protection only compared with 6% who use them for family planning purposes only. In five countries, the two proportions are about the same (Benin, Kenya, Madagascar, Senegal, and Zimbabwe), whereas in Ghana, more men use condoms for pregnancy pre- vention only. In four countries, men aged 15 to 29 are as likely to report condom use at last intercourse for pregnancy prevention only as for both purposes (Ghana, Madagascar, Mali, and Uganda; Table 4, columns 5 and 6). In only four countries (Burkina Faso, Kenya, Mozambique, and Senegal) do more men use the condom for dual protection rather than for either disease or pregnancy prevention only (Table 4, column 6 vs. columns 4 and 5). Men in their 20s are about as likely to report con- dom use for disease prevention only as for pregnancy prevention only in 7 of the 18 study countries (Benin, Burkina Faso, Madagascar, Malawi, Mozambique, Senegal, and Zimbabwe; Table 4, columns 12 and 13). In the other countries—with the exception of Ghana and Kenya where more men use the condom for pregnancy prevention only—men are more likely to be using a condom for disease prevention only rather than for pregnancy prevention alone. In three countries (Burkina Faso, Kenya, and Senegal), notice- ably more men use the condom for dual protection than for either reason on its own (Table 4, column 14 vs. columns 12 and 13). The percentage of men who did not use the con- dom at last intercourse is consistently higher in the 20 to 29 age group compared with the adolescent group, except in Namibia, Nigeria, and Senegal, where nonuse is the same in both age groups (Table 4, columns 7 and 11). This is likely related to the higher proportion of married men among men in their 20s. Compared with 20- to 29-year-old men, more ado- lescent men use the condom only for STI prevention in 10 of the 18 countries, whereas in four countries (Benin, Ghana, Senegal, and Zimbabwe), more ado- lescents use it only for contraceptive reasons. In sev- eral countries, the proportion using the condom for dual protection is five or more percentage points higher among men aged 15 to 19 compared with men aged 20 to 29 (Burkina Faso, Gabon, Ghana, Kenya, Mozambique, Rwanda, and Uganda; Table 4, columns 10 and 14). As noted earlier, having extramarital sexual rela- tionships or having more than one sexual partner (among unmarried young men) is not uncommon in Sub-Saharan Africa. In a region where the rapid spread of the HIV pandemic is believed to be mostly through unprotected sexual contact, this behavior is believed to expose men and their partners to the risk of STIs/HIV (Carael, Cleland, & Ingham, 1994). Similarly, there is likely to be a positive association between having unprotected sexual intercourse with multiple partners and the risk of unintended preg- nancy. Therefore, men who have multiple partners would be expected to be more likely to use the con- dom to protect themselves and/or their partners from both or either of the risks of STIs/HIV and unin- tended pregnancy than monogamous men. This is in fact the case in all but 2 of the 18 study countries (Table 5): Young men who have extramarital sex or (if single) who have had more than one sexual partner in the past year are more likely to use the condom at last intercourse than those who have not. Reasons for using the condom at last intercourse among men aged 15 to 29 according to whether or not they engaged in sex with multiple or extramari- tal partners in the 12 months before the survey are shown in Table 5. The pattern of reporting across reasons noted in Table 4 for all men in the 15 to 29 age group and for both age groups is reflected in this case: In most of the countries, young men, whether or not they have multiple partners, are more likely to report using the condom at last intercourse for disease prevention as compared with pregnancy preven- tion. However, important differences exist between multiple-partnered and monogamous men. In 11 coun- tries, men who had multiple or extramarital partners were substantially more likely to report condom use for disease prevention only than for family planning purposes only (Table 5, columns 3 and 4); in 7 of these countries, the percentage that reported use of the method for disease prevention only is more than twice as high as the proportion that reported use for pregnancy prevention only. As expected, men whose partners were their wife/fiancée or girlfriend at last intercourse report less use of the condom than men whose partners were casual friends or sex workers (Table 6, columns 2 and 6). However, men with a steady partner still reported STI prevention more often than pregnancy prevention as the reason for condom use in several countries, most notably in Namibia and Mali (41% vs. 5% and 16% vs. 4%). Only in Burkina Faso, Kenya, and Mozambique did the majority of users with steady partners report using condoms for dual protection (Table 6, column 5). In all but a few countries, men with a casual partner were much more likely to report 69 N 1) 70 Table 5. Percentage of Currently Sexually Activea Men Aged 15 to 29, Who Used the Condom at Last Intercourse by Country, According to Number of Partners in the Past 12 Months and Reason for Using the Method Note: STI, sexually transmitted infection. a. “Currently sexually active” refers to those who had sexual intercourse in the last 12 months before the survey. b. Data on reason for condom use at last intercourse is not available for the most recent surveys in Ethiopia (2005), Rwanda (2005), Uganda (2006), and Zimbabwe (2006). using the condom for STI prevention only than for pregnancy prevention only. In three countries (Ghana, Kenya, and Senegal), the large majority of men with a casual partner who were users reported using the condom for dual protection (Table 6, column 9). Multivariate Analysis of Predictors of Reasons for Using the Condom Multivariate analyses were carried out for 17 of the 18 study countries for which information is avail- able: In the case of one country, Ethiopia, the num- ber of cases in the four categories of the dependent variable (reason for using the condom at last sex) was not large enough to permit analysis. Table 7 presents the relative risks of the effects of each explanatory factor (one panel on each of the behav- ioral measures and social economic characteristics) on reason for using the condom at last intercourse among men aged 15 to 29 who were sexually active in the past 12 months. Number of partners is a strong predictor of reason for using the condom in 10 countries (Table 7, panel 1). In Burkina Faso, Kenya, Rwanda, Senegal, Tanzania, Uganda, and Zimbabwe, men aged 15 to 29 who had multiple or extramarital partners in the last year are 2 to nearly 9 times more likely as their monog- amous counterparts to use the condom for disease prevention only than to not use the method at all. Similarly, in Burkina Faso, Mali, Senegal, and Uganda, young men who have multiple or extramarital partners are three to nearly 7 times as likely as those who do not to use the method for pregnancy prevention only than to not use it at all. In Burkina Faso, Kenya, Senegal, Tanzania, and Uganda, engaging in multiple sexual relationships predisposes a young man to using the condom for both disease and pregnancy prevention than to not use the method (Table 7, panel 1). Educational attainment emerged as an important determinant of reason for condom use at last inter- course in several countries (Table 7, panel 4). The effect of this variable is significant in all countries but Madagascar and Rwanda: In at least three of these 71 Table 6. Percentage of Currently Sexually Activea Men Aged 15 to 29, Who Used the Condom at Last Intercourse by Country, According to Type of Partner in the Past 12 Months and Reason for Using the Method Note: STI, sexually transmitted infection. a. “Currently sexually active” refers to those who had sexual intercourse in the past 12 months before the survey. b. Data on reason for condom use at last intercourse is not available for the most recent surveys in Ethiopia (2005), Rwanda (2005), Uganda (2006), and Zimbabwe (2006). We used data from the most recent prior survey for these countries. countries (Benin, Namibia, and Zimbabwe), men with secondary or higher education are more likely than their counterparts with less than secondary education to use the method for either as well as for both purposes than to not use the method. In 8 coun- tries, men with secondary education or higher are about 2 to 4½ times as likely as their counterparts with less than secondary education to report using the condom for disease prevention only than to not use the method. In 11 countries, men with 7 or more years of education are about 2 to 6 times as likely as men with less than 7 years of education to use the method for pregnancy prevention only than to not use it at all. Similarly, in 12 countries, men with 7 or more years of education are from about 2 to nearly 9 times as predisposed as those with fewer than 7 years of education to using the condom for both purposes than to not use it at all (Table 7, panel 4). Union status is the strongest predictor of reason for condom use at last intercourse (Table 7, panel 5). In 16 countries, men who are in union (married or liv- ing together with a woman) are at least 4 times less likely than their counterparts who are not in union to use the condom for disease prevention only than to not use the method. In 8 countries (Ghana, Kenya, Malawi, Mozambique, Rwanda, Senegal, Uganda, and Zimbabwe), men in union were 2 to 19 times less likely than those who are not in a union to use the condom for pregnancy prevention only than to not use the method. Again, in all countries but 2 (Nigeria and Burkina Faso), being in union makes it considerably less likely (at least 4 times) to use the method for both disease and pregnancy prevention than to not use it at all. Exceptionally, in Burkina Faso, men in a union are more than 2 times more likely than men who are not in a union to use the condom for dual protection than to not use it. (Table 7, panel 5, column 4). Exposure to television is a significant determinant of reason for condom use at last intercourse in 12 countries (Table 7, panel 7). In 6 countries, men who watch the television at least once a week are about 2 to 5 times more likely than men who are not regularly exposed to the television to use the condom for disease prevention only compared with not using the method. 72 Table 7. Relative Risk Ratios of the Effects of Selected Socioeconomic and Behavioral Characteristics on Reason for Condom Use at Last Intercourse Among Sexually Active 15- to 29-Year-Old Men in 17 Sub-Saharan Countries, Using Multinomial Logit Regressiona (continued) 73 Table 7. (continued) (continued) 74 Table 7. (continued) Note: STI, sexually transmitted infection. a. The dependent variable has four categories: did not use, used for STI prevention only, used for pregnancy prevention only, and used for both purposes. The reference categories are as follows: 1 partner (if not in union) or 0 extramarital partner (if in union), age 15 to 19, rural, no/primary education. b. Data on reason for condom use at last intercourse is not available for the most recent surveys in Rwanda (2005), Uganda (2006), and Zimbabwe (2006). We used data from the most recent prior survey for these countries (for 1999-2001). Ethiopia is not included in these multivariate analyses because of inadequate numbers of cases for the four reasons for condom use. c. “In union” refers to men who are legally married or are living together with a female partner, and “not in union” refers to men who were formerly married or never married men. *Significant at .10. **Significant at .05. ***Significant at .01. Results for each factor are based on models that include all inde- pendent factors. Only in Senegal are young men who are exposed to tel- evision significantly less likely to use the method than to not use it (Table 7, panel 7, column 2). In Madagascar, Malawi, Mali, Mozambique, Namibia, and Nigeria men who watch television are 2 to 5 times as likely as those who do not to use the method for pregnancy prevention only than to not use it at all. Again, only in one country, Zambia, does television exposure result in significantly less use for pregnancy prevention than not using the method (Table 7, panel 7, column 3). In Burkina Faso, Gabon, Madagascar, Malawi, and Mozambique, regular exposure to televi- sion predisposes young men to using the condom (about 2 to 6 times more likely than those with no or little exposure) for both disease and pregnancy pre- vention than to not use the method. Age exerts significant effects on the reason for using condoms at last sex in 10 of the 17 countries (Table 7, panel 2). For example, in Senegal, men in their 20s are about 3.5 times as likely as adolescent men to use the condom for disease prevention only and about twice more likely for both purposes than to not use the method (Table 7, panel 2, column 2). In Malawi, men aged 20 to 29 are more than 4 times more likely than adolescents to use the method for pregnancy prevention only than to not use it (Table 7, panel 2, column 3). Similarly, in Nigeria, the older men are nearly 4 times more likely to use a condom for dual protection than not to use it (Table 7, panel 2, column 4). Residence emerges as a strong determinant of reason for using condoms at last intercourse in Benin, 75 Burkina Faso, Madagascar, Mozambique, Nigeria, Rwanda, Senegal, and Uganda (Table 7, panel 3). In Rwanda, urban residents are nearly 9 times more likely than their rural counterparts to report condom use for pregnancy prevention only, as well as nearly 4 times more likely for dual protection, than to not use the method. In Burkina Faso, urban residence pre- disposes young men to using the method for both disease and pregnancy prevention only and for dual protection than to not use it at all. Frequent exposure to the radio is a significant predictor of reason for condom use in many coun- tries (Table 7, panel 6) but less often than exposure to television. For example, only in Uganda and Gabon, are young men who listen to the radio more likely to use the condom for pregnancy prevention only than to not use it (Table 7, panel 6, column 3). Discussion With the current high prevalence of HIV in Sub- Saharan Africa, the need to understand more about the factors that are associated with adopting behav- iors that are capable of preventing HIV/STIs is unquestionable. Until vaccines against HIV/AIDS are developed, their efficacy established, and they become widely available and used, attempts to stem the spread of HIV in the region must include efforts to promote correct and consistent use of the con- dom among sexually active people. Furthermore, the fact that the condom, when used appropriately, offers effective protection against pregnancy makes it an ideal method to promote in Sub-Saharan Africa, where unintended pregnancy, especially for women at both ends of the childbearing age, is also a major reproductive health concern. Findings from this article indicate that the major- ity of young men aged 15 to 29 in Sub-Saharan Africa have initiated sexual intercourse, a substantial propor- tion of them continue to be sexually active, and most sexually active young men are not in a union. Furthermore, many men have had two or more sexual partners in the past year, thereby putting themselves and their partners at increased risk of contracting and transmitting STIs, including HIV. In addition, having more than one sexual partner likely puts a man at greater risk of contributing to the high level of unin- tended pregnancy in the region. It is evident from the findings presented here that the need for protection against STIs and unintended pregnancy among men in this region is real. It is for this reason that condom use (C) is currently widely promoted as one of the three components of the ABC approach to HIV prevention— the other two being abstinence (A) and mutual monogamy (B for “Be faithful”)—or, alternatively, as a single method that simultaneously offers dual protection—against STIs and unintended pregnancy (Adeokun, Mantell, Weiss, Delana, & Jagha, 2002; Smith, McFeyden, Harrison, & Zuma, 2002). Findings from this article indicate that most young men in Sub-Saharan Africa know about the condom as a method of family planning. Other sources have indicated that knowledge of condom use for STI/HIV prevention is high (Bankole & Singh, 2001). However, the well-known demographic con- cept termed the KAP-gap is clearly evident in regard to condom knowledge and use. Although most young men know about the condom in all the study coun- tries, in all but two of these countries (Burkina Faso and Namibia), the majority of those who are sexually experienced have not used the method at last inter- course in the last 12 months. This is a matter for con- cern in a region where the transmission of HIV is spreading rapidly and where the risk of contracting other STIs or the risk of experiencing unintended pregnancy is also very high. One positive finding, however, is that young men who are more at risk of contracting or transmitting STIs or causing unintended pregnancy, by having sexual intercourse with two or more partners, are more likely to use the condom than men who have had one partner in the past year. This suggests that these men are probably aware of these risks and are trying to minimize its occurrence by using the method to protect themselves and/or their partners. For exam- ple, a number of studies have found that although use of the condom is hardly tolerated within marriage or in a steady relationship, it is more frequently used in extramarital or casual relationships to prevent STIs or unintended pregnancy (Maharaj, 2001). The fact that those who need the condom for dis- ease and pregnancy prevention are more likely to be using the method indicates that the effort to promote the understanding that the condom protects against STIs and/or unintended pregnancy is working at least to some extent, in terms of making the information and the method available. Furthermore, the fact that the evidence from men's stated reasons for using the condom also confirms that those who are more at risk of STIs and/or unintended pregnancies are more likely to report using the method for both purposes than those who are less at risk is reassuring. However, this does not disguise the fact that many men who need the condom are not using it. This is evident from the fact that 39% to 94% of sexually active men in the 15 76 to 29 age group did not use the method at last inter- course (Table 4, column 3). Men who do not use the condom can contribute significantly to the continued spread of the HIV epidemic. Furthermore, among those who are using the condom, it is not known how correctly or consistently these men are using the method. However, evidence from another study in Burkina Faso, Ghana, Malawi, and Uganda among adolescents shows that many young men do not know how to use condoms correctly, and many of the users do not use it consistently (Bankole, Ahmed, Neema, Ouedraogo, & Konyani, 2007). For instance, between 50% (in Ghana) and 68% (in Burkina Faso) of men aged 15 to 19 who know about the condom responded correctly to the following three statements about cor- rect condom use: The condom should always be put on before sexual intercourse starts; it should be put on the penis only if the penis is fully erect or stiff; and it can be used more than once (Bankole et al., 2007). With respect to consistent use of the method, the study reported that between 20% (in Malawi) and 47% (in Ghana) of young men aged 15 to 19 who had more than two sexual acts in the past 3 months and used condoms used the method consistently. These findings suggest that more concerted effort is, therefore, needed to get more young people to use the method. More research is needed to find out more about the level of incorrect and inconsistent use of condoms to assess program needs for improving men's knowledge of how to use the condom. Several reasons have been advanced for nonuse of the condom: These include the perception that use of the condom implies that the individual is involved in an extramarital relationship or has multiple partners, that condom use reduces sexual pleasure, and that it may cause men to lose an erection (Tweedie & Witte, 2000). Others have complained about the cost of obtaining it as well as its accessibility. As indicated from a recent report based on a study in four Sub- Saharan countries, some young men attach fear, embarrassment, and shame to going to facilities, per- haps including stores, to obtain or buy condoms (Biddlecom, Hessburg, Singh, Bankole, & Darabi, 2007). All these factors must be critically examined with a view to addressing them. In the case of accessi- bility, a lot can be done on the information side to assure people that it is all right to buy condoms and to educate providers to be sensitive, tolerant, and friendly. It is not very clear how much cost is an issue in Sub-Saharan Africa, but Neema, Ahmed, Kibombo, and Bankole (2006) reported that cost is one of the major barriers to young people obtaining contraceptive services in Uganda. In addition, a report from 2001 suggests that condoms may be in short supply in the region (Shelton & Johnson, 2001). The report indi- cates that the overall provision of condoms was about 4.6 per man aged 15 to 59 per year. According to the report, if the supply in the 6 countries with the high- est levels, which amounts to an average of about 17 condoms per man, is taken as the standard for the entire region, another 1.9 billion condoms will need to be made available per year. Both donors and national governments should continue to make efforts to make the condom available in these countries. As noted by Shelton and Johnson (2001), “Relative to the enormity of the HIV/AIDS pandemic in Africa, providing con- doms is cheap and cost-effective. All aspects of HIV control are important, but a first priority must be prevention” (p. 139). This article indicates substantial differentials in the levels of condom use as well as in reasons for using the method across sociodemographic sub- groups. The association is particularly striking for education, union status, number of partners, and exposure to either television or radio. Therefore, more efforts to promote change in behavior, especially among groups with very low use of condoms, high risk of HIV/STIs, and/or unintended pregnancy, including condom use for those who choose to be sexually active, are clearly needed. Policy makers and service providers in each country should pay more attention to identifying the subgroups who need special atten- tion because the situation varies across countries. Education remains a powerful force for changing behavior (Ankrah, 1996). For example, young men who are in school have better access to sexual and reproductive health information and services; they are also less likely than their counterparts who are out of school to have multiple partners and more likely to use the condom (Ndyanabangi, Kipp, & Diesfeld, 2004). Efforts that are ongoing in most countries to increase educational attainment will clearly also ben- efit young men's health, and school-based programs about HIV/STIs and unintended pregnancy preven- tion provide a mechanism for further improving the preventive behaviors of in-school youth. In addition, however, policy makers need to pay particular atten- tion to providing information and improving access for the out-of-school group of adolescents. Along these same lines, the provision of information, educa- tion, and counseling through all forms of media should be encouraged and promoted. The targeted use of the radio and television is an important option, given that greater exposure to these media is linked to 77 ere formerly married or S S^ x 11 y 78 more condom use in many of the study countries. This finding suggests that the radio and television are potentially useful means for increasing knowledge and for changing attitudes and behavior. References Adeokun, L., Mantell, J.E., Weiss, E., Delana, G.E., & Jagha, T. (2002). Promoting dual protection in family planning clinics in Ibada, Nigeria. International Family Planning Perspectives , 28, 87-95. Alan Guttmacher Institute. (2003). In their own right: Addressing the sexual and reproductive health needs of men worldwide. New York: Alan Guttmacher Institute. Ankrah, E.M. (1996, February 13). Adolescence: HIV and AIDS in Sub-Saharan Africa. Paper presented at the Workshop on Adolescent Reproductive Health in Sub-Saharan Africa Center for Development and Population Activities (CEDPA). Bankole, A., & Singh, S. (2001, August). Men and condom use for dual protection in Sub-Saharan Africa. Paper presented at the IUSSP meeting, Salvador de Bahia, Brazil. Bankole, A., Singh, S., Woog, V., & Wulf, D. (2003). Risk and protection: Youth and HIV/AIDS in Sub-Saharan Africa. New York: Alan Guttmacher Institute. Bankole, A., Ahmed, F.A., Neema, S., Ouedraogo, C., & Konyani, S. (2007). Knowledge of correct condom use and consistency of use among adolescents in four countries in Sub-Saharan Africa. African Journal of Reproductive Health, 11, 197-220. Biddlecom, A.E., Hessburg, L., Singh, S., Bankole, A., & Darabi, L. (2007). Protecting the next generation in Sub-Saharan Africa: Learning from adolescents to prevent HIV and unintended pregnancy . New York: Guttmacher Institute . Carael, M., Cleland, J., & Ingham, R. (1994). Extramarital sex: implications of survey results for STD/HIV transmission. Health Transition Review, 4, 153-172. Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Kenya], & ORC Macro. (2004). Kenya Demographic and Health Survey 2003. Calverton, MD: CBS, MOH, and ORC Macro. Curtis, S.L., & Neitzel, K. (1996). Contraceptive knowledge, use and sources. DHS Comparative Studies No. 19. Davis, K.R., & Weller, S.C. (1999). The effectiveness of condoms in reducing heterosexual transmission of HIV. Family Planning Perspectives, 31, 272-279. Ghana Statistical Services (GSS), & Macro International Inc. (MI). (1999). Ghana Demographic and Health Survey 1998. Calverton, MD: GSS and MI. Ghana Statistical Services (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), & ORC Macro. (2004). Ghana Demographic and Health Survey 2003. Calverton, MD : GSS, NMIMR, and ORC Macro. Hersh, L., Lane, C., & Feijoo, A. (1998). Adolescent sexual and reproductive health in Sub-Saharan Africa. Washington, DC: Advocates for Youth. Hearst, N., & Chen, S. (2004). Condom promotion for AIDS prevention in the developing world: Is it working? Studies in Family Planning, 35, 39-47. Joint UN Programme on HIV/AIDS (UNAIDS). ( 2000). Report on the global HIV/AIDS epidemic. Geneva, Switzerland: UNAIDS. Kiragu, K. (2001). Youth and HIV/AIDS: Can we avoid catastrophe? (Rep. No. L (12)). Baltimore, MD: Population Council. Maharaj, P. (2001). Obstacles to negotiating dual protection: Perspectives of men and women. African Journal of Reproductive Health, 5, 150-161. Messersmith, L.J., Kane, T.T., Odebiyi, A.I., & Adewuyi, A.A. (2000). Who's at risk? Men's STD experience and condom use in Southwest Nigeria. Studies in Family Planning, 31, 203-216. Ndyanabangi, B., Kipp, W., & Diesfeld, H. (2004). Reproductive health behaviour among in-school and out-of-school youth in Kabarole district, Uganda. African Journal of Reproductive Health, 8, 55-67. Neema, S., Ahmed, F.A., Kibombo, R., & Bankole, A. (2006). Adolescent sexual and reproductive health in Uganda: Results from the 2004 National Survey of Adolescents. New York: Guttmacher Institute. Salem, R. (2004). Men's surveys: New findings. Population Reports, Series M, No. 18. Baltimore: Johns Hopkins Bloomberg School of Public Health, The INFO Project. Shelton, J.D., & Johnson, B. (2001). Condom gap in Africa: Evidence from donor agencies and key informants. British Medical Journal, 323, 139. Singh, S., & Bankole, A. (2001, August). Gender differences in sexual and contraceptive behavior: Young people in Sub-Saharan Africa and Latin America and the Caribbean . Paper presented at the IUSSP meeting, Salvador de Bahia, Brazil. Smith, J., McFeyden, L., Harrison, A., & Zuma, K. (2002). Where is the condom: Contraceptive practice in a rural district in South Africa. African Journal of Reproductive Health, 6, 71-78. Stata Corp. (2003). Stata Statistical Software (Release 8.0) [Computer software]. College Station, TX: Stata Corporation. Summers, T., Kates, J., & Murphy, G. (2002). The tip of the iceberg: The global impact of HIV/AIDS on youth. Menlo Park, CA: Henry J. Kaiser Family Foundation. Trussell, J. (2004). The essentials of contraception: Efficacy, safety, and personal considerations. In R. A. Hatcher (Ed.), Contraceptive technology (18th ed., pp. 221-252). New York: Ardent Media. Tweedie, I., & Witte, K. (2000). Ghana youth reproductive health survey report . Accra, Ghana: Ghana Social Marketing Foundation. UNAIDS & WHO. (2002). AIDS Epidemic Update. Geneva, Switzerland: UNAIDS.</meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><notes>
<p><list list-type="order">
<list-item><p>1. The two questions that elicit this information are “When was the last time you had sexual intercourse?” and “The last time you had sexual intercourse, was a condom used?”</p></list-item>
<list-item><p>2. The response categories provided were “own concern to prevent STD/HIV,” “own concern to prevent pregnancy,” “own concern to prevent both STD/HIV and pregnancy,” “did not trust partner/feel partner has other partners,” “partner insisted,” and “don't know.”</p></list-item>
</list></p>
</notes><ref-list>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Adeokun, L.</surname></name>, <name name-style="western"><surname>Mantell, J.E.</surname></name>, <name name-style="western"><surname>Weiss, E.</surname></name>, <name name-style="western"><surname>Delana, G.E.</surname></name>, & <name name-style="western"><surname>Jagha, T.</surname></name> (<year>2002</year>). <article-title>Promoting dual protection in family planning clinics in Ibada, Nigeria</article-title>. <source>International Family Planning Perspectives</source> , <volume>28</volume>, <fpage>87</fpage>-<lpage>95</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Alan Guttmacher Institute.</surname></name> (<year>2003</year>). <source>In their own right: Addressing the sexual and reproductive health needs of men worldwide</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>Alan Guttmacher Institute</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="confproc" xlink:type="simple"><name name-style="western"><surname>Ankrah, E.M.</surname></name> (<conf-date>1996</conf-date>, February 13). <article-title>Adolescence: HIV and AIDS in Sub-Saharan Africa</article-title>. <conf-name>Paper presented at the Workshop on Adolescent Reproductive Health in Sub-Saharan Africa Center for Development and Population Activities (CEDPA)</conf-name>.</citation>
</ref>
<ref>
<citation citation-type="confproc" xlink:type="simple"><name name-style="western"><surname>Bankole, A.</surname></name>, & <name name-style="western"><surname>Singh, S.</surname></name> (<conf-date>2001</conf-date>, August). <article-title>Men and condom use for dual protection in Sub-Saharan Africa</article-title>. <conf-name>Paper presented at the IUSSP meeting</conf-name>, Salvador de Bahia, Brazil.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Bankole, A.</surname></name>, <name name-style="western"><surname>Singh, S.</surname></name>, <name name-style="western"><surname>Woog, V.</surname></name>, & <name name-style="western"><surname>Wulf, D.</surname></name> (<year>2003</year>). <source>Risk and protection: Youth and HIV/AIDS in Sub-Saharan Africa</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>Alan Guttmacher Institute</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Bankole, A.</surname></name>, <name name-style="western"><surname>Ahmed, F.A.</surname></name>, <name name-style="western"><surname>Neema, S.</surname></name>, <name name-style="western"><surname>Ouedraogo, C.</surname></name>, & <name name-style="western"><surname>Konyani, S.</surname></name> (<year>2007</year>). <article-title>Knowledge of correct condom use and consistency of use among adolescents in four countries in Sub-Saharan Africa</article-title>. <source>African Journal of Reproductive Health</source>, <volume>11</volume>, <fpage>197</fpage>-<lpage>220</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Biddlecom, A.E.</surname></name>, <name name-style="western"><surname>Hessburg, L.</surname></name>, <name name-style="western"><surname>Singh, S.</surname></name>, <name name-style="western"><surname>Bankole, A.</surname></name>, & <name name-style="western"><surname>Darabi, L.</surname></name> (<year>2007</year>). <source>Protecting the next generation in Sub-Saharan Africa: Learning from adolescents to prevent HIV and unintended pregnancy</source> . <publisher-loc>New York</publisher-loc>: <publisher-name>Guttmacher Institute</publisher-name> .</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Carael, M.</surname></name>, <name name-style="western"><surname>Cleland, J.</surname></name>, & <name name-style="western"><surname>Ingham, R.</surname></name> (<year>1994</year>). <article-title>Extramarital sex: implications of survey results for STD/HIV transmission</article-title>. <source>Health Transition Review</source>, <volume>4</volume>, <fpage>153</fpage>-<lpage>172</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Kenya], & ORC Macro.</surname></name> (<year>2004</year>). <source>Kenya Demographic and Health Survey 2003</source>. <publisher-loc>Calverton, MD</publisher-loc>: <publisher-name>CBS, MOH, and ORC Macro</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Curtis, S.L.</surname></name>, & <name name-style="western"><surname>Neitzel, K.</surname></name> (<year>1996</year>). <source>Contraceptive knowledge, use and sources</source>. DHS Comparative Studies No. 19.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Davis, K.R.</surname></name>, & <name name-style="western"><surname>Weller, S.C.</surname></name> (<year>1999</year>). <article-title>The effectiveness of condoms in reducing heterosexual transmission of HIV</article-title>. <source>Family Planning Perspectives</source>, <volume>31</volume>, <fpage>272</fpage>-<lpage>279</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Ghana Statistical Services (GSS), & Macro International Inc. (MI).</surname></name> (<year>1999</year>). <source>Ghana Demographic and Health Survey 1998</source>. <publisher-loc>Calverton, MD</publisher-loc>: <publisher-name>GSS and MI</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Ghana Statistical Services (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), & ORC Macro.</surname></name> (<year>2004</year>). <source>Ghana Demographic and Health Survey 2003</source>. <publisher-loc>Calverton, MD</publisher-loc> : <publisher-name>GSS, NMIMR, and ORC Macro</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Hersh, L.</surname></name>, <name name-style="western"><surname>Lane, C.</surname></name>, & <name name-style="western"><surname>Feijoo, A.</surname></name> (<year>1998</year>). <source>Adolescent sexual and reproductive health in Sub-Saharan Africa</source>. <publisher-loc>Washington, DC</publisher-loc>: <publisher-name>Advocates for Youth</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Hearst, N.</surname></name>, & <name name-style="western"><surname>Chen, S.</surname></name> (<year>2004</year>). <article-title>Condom promotion for AIDS prevention in the developing world: Is it working</article-title>? <source>Studies in Family Planning</source>, <volume>35</volume>, <fpage>39</fpage>-<lpage>47</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Joint UN Programme on HIV/AIDS (UNAIDS).</surname></name> ( <year>2000</year>). <source>Report on the global HIV/AIDS epidemic</source>. <publisher-loc>Geneva</publisher-loc>, Switzerland: <publisher-name>UNAIDS</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Kiragu, K.</surname></name> (<year>2001</year>). <source>Youth and HIV/AIDS: Can we avoid catastrophe? (Rep. No. L (12))</source>. <publisher-loc>Baltimore, MD</publisher-loc>: <publisher-name>Population Council</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Maharaj, P.</surname></name> (<year>2001</year>). <article-title>Obstacles to negotiating dual protection: Perspectives of men and women</article-title>. <source>African Journal of Reproductive Health</source>, <volume>5</volume>, <fpage>150</fpage>-<lpage>161</lpage>.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Messersmith, L.J.</surname></name>, <name name-style="western"><surname>Kane, T.T.</surname></name>, <name name-style="western"><surname>Odebiyi, A.I.</surname></name>, & <name name-style="western"><surname>Adewuyi, A.A.</surname></name> (<year>2000</year>). <article-title>Who's at risk? Men's STD experience and condom use in Southwest Nigeria</article-title>. <source>Studies in Family Planning</source>, <volume>31</volume>, <fpage>203</fpage>-<lpage>216</lpage>.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Ndyanabangi, B.</surname></name>, <name name-style="western"><surname>Kipp, W.</surname></name>, & <name name-style="western"><surname>Diesfeld, H.</surname></name> (<year>2004</year>). <article-title>Reproductive health behaviour among in-school and out-of-school youth in Kabarole district, Uganda</article-title>. <source>African Journal of Reproductive Health</source>, <volume>8</volume>, <fpage>55</fpage>-<lpage>67</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Neema, S.</surname></name>, <name name-style="western"><surname>Ahmed, F.A.</surname></name>, <name name-style="western"><surname>Kibombo, R.</surname></name>, & <name name-style="western"><surname>Bankole, A.</surname></name> (<year>2006</year>). <source>Adolescent sexual and reproductive health in Uganda: Results from the 2004 National Survey of Adolescents</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>Guttmacher Institute</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Salem, R.</surname></name> (<year>2004</year>). <source>Men's surveys: New findings. Population Reports, Series M, No. 18</source>. <publisher-loc>Baltimore</publisher-loc>: <publisher-name>Johns Hopkins Bloomberg School of Public Health, The INFO Project</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Shelton, J.D.</surname></name>, & <name name-style="western"><surname>Johnson, B.</surname></name> (<year>2001</year>). <article-title>Condom gap in Africa: Evidence from donor agencies and key informants</article-title>. <source>British Medical Journal</source>, <volume>323</volume>, <fpage>139</fpage>.</citation>
</ref>
<ref>
<citation citation-type="confproc" xlink:type="simple"><name name-style="western"><surname>Singh, S.</surname></name>, & <name name-style="western"><surname>Bankole, A.</surname></name> (<conf-date>2001</conf-date>, August). <article-title>Gender differences in sexual and contraceptive behavior: Young people in Sub-Saharan Africa and Latin America and the Caribbean</article-title> . <conf-name>Paper presented at the IUSSP meeting</conf-name>, Salvador de Bahia, Brazil.</citation>
</ref>
<ref>
<citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Smith, J.</surname></name>, <name name-style="western"><surname>McFeyden, L.</surname></name>, <name name-style="western"><surname>Harrison, A.</surname></name>, & <name name-style="western"><surname>Zuma, K.</surname></name> (<year>2002</year>). <article-title>Where is the condom: Contraceptive practice in a rural district in South Africa</article-title>. <source>African Journal of Reproductive Health</source>, <volume>6</volume>, <fpage>71</fpage>-<lpage>78</lpage>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Stata Corp.</surname></name> (<year>2003</year>). <source>Stata Statistical Software (Release 8.0) [Computer software]</source>. <publisher-loc>College Station, TX</publisher-loc>: <publisher-name>Stata Corporation</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Summers, T.</surname></name>, <name name-style="western"><surname>Kates, J.</surname></name>, & <name name-style="western"><surname>Murphy, G.</surname></name> (<year>2002</year>). <source>The tip of the iceberg: The global impact of HIV/AIDS on youth</source>. <publisher-loc>Menlo Park, CA</publisher-loc>: <publisher-name>Henry J. Kaiser Family Foundation</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Trussell, J.</surname></name> (<year>2004</year>). <source>The essentials of contraception: Efficacy, safety, and personal considerations</source>. In <name name-style="western"><surname>R. A. Hatcher</surname></name> (Ed.), <source>Contraceptive technology</source> (<edition>18</edition>th ed., pp. <fpage>221</fpage>-<lpage>252</lpage>). <publisher-loc>New York</publisher-loc>: <publisher-name>Ardent Media</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Tweedie, I.</surname></name>, & <name name-style="western"><surname>Witte, K.</surname></name> (<year>2000</year>). <source>Ghana youth reproductive health survey report</source> . <publisher-loc>Accra</publisher-loc>, Ghana: <publisher-name>Ghana Social Marketing Foundation</publisher-name>.</citation>
</ref>
<ref>
<citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>UNAIDS & WHO.</surname></name> (<year>2002</year>). <source>AIDS Epidemic Update</source>. <publisher-loc>Geneva</publisher-loc>, Switzerland: <publisher-name>UNAIDS</publisher-name>.</citation>
</ref>
</ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa</title></titleInfo><name type="personal"><namePart type="given">Akinrinola</namePart><namePart type="family">Bankole</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Guttmacher Institute, New York, New York,</affiliation><affiliation>E-mail: abankole@guttmacher.org</affiliation></name><name type="personal"><namePart type="given">Susheela</namePart><namePart type="family">Singh</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Guttmacher Institute, New York, New York</affiliation></name><name type="personal"><namePart type="given">Rubina</namePart><namePart type="family">Hussain</namePart><namePart type="termsOfAddress">MPH</namePart><affiliation>Guttmacher Institute, New York, New York</affiliation></name><name type="personal"><namePart type="given">Gabrielle</namePart><namePart type="family">Oestreicher</namePart><namePart type="termsOfAddress">MS</namePart><affiliation>Guttmacher Institute, New York, New York</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>SAGE Publications</publisher><place><placeTerm type="text">Sage CA: Los Angeles, CA</placeTerm></place><dateIssued encoding="w3cdtf">2009-03</dateIssued><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.</abstract><subject><genre>keywords</genre><topic>condoms</topic><topic>young men</topic><topic>sexually transmitted infections</topic><topic>HIV</topic><topic>unintended pregnancy</topic><topic>Sub-Saharan Africa</topic></subject><relatedItem type="host"><titleInfo><title>American Journal of Men's Health</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1557-9883</identifier><identifier type="eISSN">1557-9891</identifier><identifier type="PublisherID">JMH</identifier><identifier type="PublisherID-hwp">spjmh</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>3</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>60</start><end>78</end></extent></part></relatedItem><identifier type="istex">FA90FD55B1E7525196F32358B9CC4CE98DCC6F31</identifier><identifier type="DOI">10.1177/1557988308322394</identifier><identifier type="ArticleID">10.1177_1557988308322394</identifier><recordInfo><recordContentSource>SAGE</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaGhanaV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000301 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 000301 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaGhanaV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:FA90FD55B1E7525196F32358B9CC4CE98DCC6F31
|texte= Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa
}}
| This area was generated with Dilib version V0.6.31. |  |