Masculinities and Condom Use Patterns among Young Rural South African Men: A Cross-Sectional Baseline Survey

This research based in the Eastern Cape, South Africa, tested the hypothesis that gender and relationship constructs are associated with condom use among young men living in rural South Africa. Because, as stated here, "greater male power in sexual relationships accounts for much of the spread of HIV amongst women, ...[u]nderstanding what factors influence men’s ideas and practices related to condoms is valuable for explaining why men do not use condoms....Notions of ideal manhood in South Africa are potentially prescriptive of male sexuality thus accounting for the behaviours, which may lead to men being at greater HIV risk." [Footnotes are removed by the editor throughout.]
 
Through a cross-sectional baseline survey from an IsiXhosa questionnaire asking about sexual behaviour and relationships of 1,219 men aged 15–26 years, researchers examined the associations between "aspects of gender and relationships and violence and risky sexual practices, and three categories of condom use, that is, inconsistent condom use in comparison with consistent and non-condom use."
 
According to the results, 47.7% of men never used condoms, when 36.9% were inconsistent and 15.4% were consistent with any partner in the past year. "Inconsistent and consistent condom users were slightly older and had higher socioeconomic status and had more money than never users. Consistent users showed progressive gender relations attitudes and less relationship control compared to other groups....Having 3 or more sexual partners was two times more likely amongst inconsistent users....Inconsistent users (62.8%, 95% CI 52.5, 73.1) were also more likely to perpetrate violence against an intimate partner compared to never (39.7%, 95% CI 33.1, 46.4) and consistent users (36.6%, 95% CI 24.8, 48.3). 28.2% of inconsistent users reported perpetrating rape against a non-partner more often than their consistent (15.4%) or never (11.4%) condom use counterparts."

"Condom use patterns differed in association with gender relations attitudes: never users were significantly more conservative than inconsistent or consistent users." Three gender positions emerged indicating that:

• inconsistent condom users were most physically and/or sexually violent and sexually risky;
• never users had more conservative gender attitudes but were less violent and sexually risky; and
• consistent condom users were less conservative, less violent, and sexually risky and had fewer sexual partners than inconsistent users.

Conclusions include the following: "The confluence of conservative gender attitudes, perpetration of violence against women and sexual risk taking distinguished inconsistent condom users as the most risky compared to never condom users, and rendered inconsistent use one of the basic negative attributes of dominant masculinities in the Eastern Cape, South Africa.....Changing non- and inconsistent condom use to consistent use is not only possible amongst youth, but also an important step in their efforts to prevent HIV infection and should be optimally promoted in HIV risk reduction interventions going beyond the ABC messaging and condom demonstrations. Using a condom consistently should be promoted as a positive, progressive and healthy attribute of successful masculinity, along with promotion of gender equity and male participation in sexual and reproductive health. Programmes that are targeted at engaging men in HIV prevention and building gender equity, namely Men as Partners and Stepping Stones, have demonstrated positive behaviour change effects and were scientifically tested within the South Africa context, yet the determination to roll these programmes out at a national scale seems to be lacking."