Prevention Science

, Volume 20, Issue 1, pp 147–156 | Cite as

The Relationship Between Body Image Perceptions and Condom Use Outcomes in a Sample of South African Emerging Adults

  • Rosalie CoronaEmail author
  • Kristina B. Hood
  • Firoza Haffejee


HIV continues to be a health priority in South Africa. Consistent condom use helps prevent HIV, yet less than half of South African emerging adults use condoms consistently. Cultural beliefs about illnesses (e.g., being thin is perceived to be a sign of HIV infection) suggest that body image perceptions may play a role in emerging adults’ condom use outcomes. We explored the relationships between body image perceptions (i.e., body dissatisfaction, body consciousness) and condom use outcomes (e.g., attitudes, negotiation efficacy, past use) in a sample of South African emerging adults. Participants (n = 379) recruited from university residences completed an anonymous survey. Participants’ mean age was 21.79 years, 54.6% were female, 96.1% identified as Black African, and 73.5% reported primarily speaking IsiZulu. For women, the relationship between body dissatisfaction and condom negotiation efficacy was mediated by body consciousness and condom use attitudes after controlling for BMI, relationship status, and mental health symptoms. Further, the relationship between body dissatisfaction and past condom use was mediated by body consciousness. These results were not significant for men. Findings from this study suggest that integrating messages about body image perceptions into HIV prevention efforts targeting South African emerging adult women may be warranted.


Body image perceptions Condom use South Africa 



This work was supported by the National Research Foundation of South Africa, under [grant number 99315]. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the NRF.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee from the Durban University of Technology, Durban, South Africa. Ethical clearance was obtained prior to data collection (IREC 084/16).

Informed Consent

Informed consent was obtained from all participants in the study.


  1. Blashill, A. J., & Safren, S. A. (2015). Body dissatisfaction and condom use self-efficacy: A meta-analysis. Body Image, 12, 73–77.CrossRefGoogle Scholar
  2. Caradas, A. A., Lambert, E. V., & Charlton, K. E. (2001). An ethnic comparison of eating attitudes and associated body image concerns in adolescent South African schoolgirls. Journal of Human Nutrition and Dietetics, 14, 111–120.CrossRefGoogle Scholar
  3. Cash, T. F. (2004). Body image: Past, present, and future. Body Image, 1, 1–5.CrossRefGoogle Scholar
  4. Cash, T. F., & Pruzinsky, T. E. (1990). Body images: Development, deviance, and change. New York: Guilford Press.Google Scholar
  5. Devine-Wright, H., Abraham, C., Onya, H., Ramatsea, S., Themane, M., & Aarø, L. E. (2015). Correlates of condom use and condom use motivation among young South Africans. Journal of Applied Social Psychology, 45, 674–683.CrossRefGoogle Scholar
  6. DiClemente, R. J., & Wingood, G. M. (1995). A randomized controlled trial of an HIV sexual risk—reduction intervention for young African American women. JAMA : The Journal of the American Medical Association, 274, 1271–1276.CrossRefGoogle Scholar
  7. Edwards, C., Tod, D., Molnar, G., & Markland, D. (2016). Perceived social pressures and the internalization of the mesomorphic ideal: The role of drive for muscularity and autonomy in physically active men. Body Image, 16, 63–69.CrossRefGoogle Scholar
  8. Evans, M., Risher, K., Zungu, N., Shisana, O., Moyo, S., Celentano, D. D., et al. (2016). Age-disparate sex and HIV risk for young women from 2002 to 2012 in South Africa. Journal of the International AIDS Society, 19, 21310.CrossRefGoogle Scholar
  9. Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorder psychopathology: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370.Google Scholar
  10. Fallon, E. A., Harris, B. S., & Johnson, P. (2014). Prevalence of body dissatisfaction among a United States adult sample. Eating Behaviors, 15, 151–158.CrossRefGoogle Scholar
  11. Gillen, M. M., Lefkowitz, E. S., & Shearer, C. L. (2006). Does body image play a role in risky sexual behavior and attitudes? Journal of Youth and Adolescence, 35, 230–242.CrossRefGoogle Scholar
  12. Haffejee, F., Koorbanally, D., & Corona, R. (2018). Condom use among South African university students in the province of KwaZulu-Natal. Sexuality & Culture, 1–11.Google Scholar
  13. Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from Accessed 6 March 2017.Google Scholar
  14. Hood, K. B., & Shook, N. J. (2013). Conceptualizing women’s attitudes towards condom use with the tripartite model. Women & Health, 53, 349–368.CrossRefGoogle Scholar
  15. Jackson, T., Zheng, P., & Chen, H. (2016). Features of objectified body consciousness and sociocultural perspectives as predictors of eating and body image disturbances among young women and men in China. Journal of Gender Studies, 25, 599–612.CrossRefGoogle Scholar
  16. Leit, R. A., Pope, H. G., & Gray, J. J. (2001). Cultural expectations of muscularity in men: The evolution of playgirl centerfolds. International Journal of Eating Disorders, 29, 90–93.CrossRefGoogle Scholar
  17. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behavior Research and Therapy, 33, 335–343.Google Scholar
  18. Maughan-Brown, B., George, G., Beckett, S., Evans, M., Lewis, L., Cawood, C., et al. (2018). HIV risk among adolescent girls and young women in age-disparate partnerships: Evidence from KwaZulu-Natal, South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes, 78, 155–162.CrossRefGoogle Scholar
  19. MacKinnon, D. (2008). Introduction to statistical mediation analysis. Routledge.Google Scholar
  20. Mchiza, Z. J., Goedecke, J. H., & Lambert, E. V. (2011). Intra-familial and ethnic effects on attitudinal and perceptual body image: A cohort of South African mother-daughter dyads. BMC Public Health, 11, 433.CrossRefGoogle Scholar
  21. Mchiza, Z. J., Parker, W. A., Makoae, M., Sewpaul, R., Kupamupindi, T., & Labadarios, D. (2015). Body image and weight control in South Africans 15 years or older: SANHANES-1. BMC Public Health, 15, 992.CrossRefGoogle Scholar
  22. McKinley, N. M., & Hyde, J. S. (1996). The objectified body consciousness scale development and validation. Psychology of Women Quarterly, 20, 181–215.CrossRefGoogle Scholar
  23. Mond, J., Van den Berg, P., Boutelle, K., Hannan, P., & Neumark-Sztainer, D. (2011). Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: Findings from the project EAT study. Journal of Adolescent Health, 48, 373–378.CrossRefGoogle Scholar
  24. Ngidi, N. D., Moyo, S., Zulu, T., Adam, J. K., & Krishna, S. B. N. (2016). Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal, South Africa. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 13, 96–105.CrossRefGoogle Scholar
  25. Paxton, S. J., Neumark-Sztainer, D., Hannan, P. J., & Eisenberg, M. E. (2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child and Adolescent Psychology, 35, 539–549.CrossRefGoogle Scholar
  26. Pope, H. G., Olivardia, R., Borowiecki, J. J., & Cohane, G. H. (2001). The growing commercial value of the male body: A longitudinal survey of advertising in women’s magazines. Psychotherapy and Psychosomatics, 70, 189–192.CrossRefGoogle Scholar
  27. Pope, M., Corona, R., & Belgrave, F. Z. (2014). Nobody’s perfect: A qualitative examination of African American maternal caregivers and their adolescent daughters’ perception of body image. Body Image: An International Journal, 11, 307–317.CrossRefGoogle Scholar
  28. Prioreschi, A., Wrottesley, S. V., Cohen, E., Reddy, A., Said-Mohamed, R., Twine, R., et al. (2017). Examining the relationships between body image, eating attitudes, BMI, and physical activity in rural and urban South African young adult females using structural equation modeling. PLoS One, 12, e0187508.CrossRefGoogle Scholar
  29. Puoane, T., Tsolekile, L., & Steyn, N. (2010). Perceptions about body image and sizes among black African girls living in Cape Town. Ethnicity and Disease, 20, 29–34.Google Scholar
  30. Roberts, A., Cash, T. F., Feingold, A., & Johnson, B. T. (2006). Are black-white differences in females’ body dissatisfaction decreasing? A meta-analytic review. Journal of Consulting and Clinical Psychology, 74, 1121–1131.CrossRefGoogle Scholar
  31. Schaefer, R., Gregson, S., Eaton, J. W., Mugurungi, O., Rhead, R., Takaruza, A., et al. (2017). Age-disparate relationships and HIV incidence in adolescent girls and young women: Evidence from Zimbabwe. AIDS, 31, 1461.CrossRefGoogle Scholar
  32. Schooler, D. (2013). Early adolescent body image predicts subsequent condom use behavior among girls. Sexuality Research & Social Policy, 10, 52–61.CrossRefGoogle Scholar
  33. Spitzack, C. (1990). Confessing excess: Women and the politics of body reduction. Albany: State University of New York Press.Google Scholar
  34. Stice, E., Hayward, C., Cameron, R., Killen, J. D., & Taylor, B. (2000). Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study. Journal of Abnormal Psychology, 109, 438–444.CrossRefGoogle Scholar
  35. Swami, V., Frederick, D. A., Aavik, T., Alcalay, L., Allik, J., Anderson, D., et al. (2010). The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the International Body Project I. Personality and Social Psychology Bulletin, 36, 309–325.CrossRefGoogle Scholar
  36. Tiggemann, M. (2013). Objectification theory: Of relevance for eating disorder researchers and clinicians? Clinical Psychologist, 17, 35–45.CrossRefGoogle Scholar
  37. Tiggemann, M., & Slater, A. (2015). The role of self-objectification in the mental health of early adolescent girls: Predictors and consequences. Journal of Pediatric Psychology, 40, 704–711.CrossRefGoogle Scholar
  38. Wild, L. G., Flisher, A. J., Bhana, A., & Lombard, C. (2004). Substance abuse, suicidality, and self-esteem in South African adolescents. Journal of Drug Education, 34, 1–17.CrossRefGoogle Scholar
  39. Wingood, G. M., DiClemente, R. J., Harrington, K., & Davies, S. L. (2002). Body image and African American females’ sexual health. Journal of Women's Health & Gender-Based Medicine, 11, 433–439.CrossRefGoogle Scholar
  40. Zhang, J., Jemmott, J. B., III, & Heeren, G. A. (2017). Sub-Saharan African university students’ beliefs about abstinence, condom use, and limiting the number of sexual partners. Behavioral Medicine, 43, 9–20.CrossRefGoogle Scholar
  41. Zuma, K., Shisana, O., Rehle, T. M., Simbayi, L. C., Jooste, S., Zungu, N., et al. (2016). New insights into HIV epidemic in South Africa: Key findings from the National HIV Prevalence, Incidence and Behaviour Survey, 2012. African Journal of AIDS Research, 15, 67–75.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Department of PsychologyVirginia Commonwealth UniversityRichmondUSA
  2. 2.Department of Basic Medical SciencesDurban University of TechnologyDurbanSouth Africa

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