The Measurement of Condom Use in Four Countries in East and Southern Africa Authors
First Online: 04 February 2012 DOI:
Cite this article as: Reynolds, H.W., Luseno, W.K. & Speizer, I.S. AIDS Behav (2012) 16: 1044. doi:10.1007/s10461-012-0146-9 Abstract
Measurement of condom use is important to assess progress in increasing use. Since 2003, the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) have included new measures of self-reported condom use. We use data from Namibia, Swaziland, Tanzania, and Zambia to compare measures of condom use accounting for type of sexual partner. Condom use at last sex ranged from 20% in Tanzania to 57% in Namibia for men, and from 12% in Tanzania to 41% in Namibia for women. Reported condom use was lower in response to questions about condom use every time with last partner (from 13 to 47% for men and from 8 to 33% for women). Condom use was highest among people with two or more partners in the last year and lowest with marital partners. Overall, the prevalence of condom use was low, and there was wide variability across the various measures, countries, sexes, and types of partner. Promotion of condom use in all partnerships, but especially in non-marital relationships and among individuals with multiple partners, remains a critical strategy. New condom use questions in the DHS and AIS expand options for measuring and studying condom use.
Keywords Condoms/utilization Eastern and Southern Africa Measurement Sexual behavior References
Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO). AIDS epidemic update: November 2009. Geneva: UNAIDS; 2009.
Hearst N, Chen S. Condom promotion for AIDS prevention in the developing world: is it working? Stud Fam Plan. 2004;35(1):39–47.
Pinkerton SD, Abramson PR. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med. 1997;44(9):1303–12.
Weller S, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;1:1–22.
Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, et al. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS. 2001;15(16):2171–9.
Olley B, Seedat S, Gxamza F, Reuter H, Stein D. Determinants of unprotected sex among HIV-positive patients in South Africa. AIDS Care. 2005;17(1):1–9.
Bunnell R, Opio A, Musinguzi J, Kirungi W, Ekwaru P, Mishra V, et al. HIV transmission risk behavior among HIV-infected adults in Uganda: results of a nationally representative survey. AIDS. 2008;22(5):617–24.
Fylkesnes K, Musonda RM, Sichone M, Ndhlovu Z, Tembo F, Monze M. Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys. AIDS. 2001;15(7):907–16.
Boerma JT, Weir SS. Integrating demographic and epidemiological approaches to research on HIV/AIDS: the proximate-determinants framework. J Infect Dis. 2005;191(Suppl 1):S61–7.
Chimbiri AM. The condom is an ‘intruder’ in marriage: evidence from rural Malawi. Soc Sci Med. 2007;64(5):1102–15.
Hendriksen ES, Pettifor A, Lee SJ, Coates TJ, Rees HV. Predictors of condom use among young adults in South Africa: the reproductive health and HIV research unit national youth survey. AJPH. 2007;97(7):1241–8.
Maharaj P, Cleland J. Condom use within marital and cohabiting partnerships in KwaZulu Natal, South Africa. Stud Fam Plan. 2004;35(2):116–24.
Bauni EK, Jarabi BO. The low acceptability and use of condoms within marriage: evidence from Nakuru district, Kenya. Afr Popul Stud. 2003;18(1):51–65.
Biraro S, Shafer L, Kleinschmidt I, Wolff B, Karabalinde A, Nalwoga A, et al. Is sexual risk taking behaviour changing in rural south-west Uganda? Behaviour trends in a rural population cohort 1993–2006. Sex Transm Infect. 2009;85(Suppl 1):i3–11.
de Walque D, Kline R. Comparing condom use with different types of partners: evidence from national HIV surveys in Africa [working paper]. Policy Research Working Paper Series 5130. Washington: The World Bank; 2009.
Noar SM, Cole C, Carlyle K. Condom use measurement in 56 studies of sexual risk behavior: review and recommendations. Arch Sex Behav. 2006;35(3):327–45.
Curtis SL, Sutherland EG. Measuring sexual behavior in the era of HIV/AIDS: the experience of demographic and health surveys and similar enquiries. Sex Transm Infect. 2004;80:ii22–7.
Sheeran P, Abraham C. Measurement of condom use in 72 studies of HIV-preventive behavior: a critical review. Patient Educ Couns. 1994;24:199–216.
Minnis AM, van der Sraten A, Gerdts C, Padian NS. A comparison of four condom-use measures in predicting pregnancy, cervical STI and HIV incidence among Zimbabwean women. Sex Transm Infect. 2010;86:231–5.
MEASURE DHS. DHS Model Questionnaire Phase 5 (2008–2013) and DHS Model Questionnaire Phase 6 (2003–2008). Calverton: MEASURE DHS, IFC Macro; ND. Available from
. Accessed 15 May 2010.
Ministry of Health and Social Services (MoHSS) [Namibia], Macro International Inc. Namibia demographic and health survey 2006–07. Windhoek/Calverton: MoHSS/Macro International Inc; 2008.
Central Statistical Office (CSO) [Swaziland], Macro International Inc. Swaziland demographic and health survey 2006–07. Mbabane: Central Statistical Office and Macro International Inc; 2008.
Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), Macro International Inc. Tanzania HIV/AIDS and malaria indicator survey 2007–08. Dar es Salaam: TACAIDS, ZAC, NBS, OCGS, and Macro International Inc; 2008.
Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc. Zambia demographic and health survey 2007. Calverton: CSO and Macro International Inc.; 2009.
Higher-risk sex, UNAIDS indicator registry [Online database]. Available from
. Accessed 28 June 2010.
Condom use during higher-risk sex, UNAIDS indicator registry [Online database]. Available from
. Accessed 28 June 2010.
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