Abstract
To evaluate whether determinants of consistent condom use vary by partner type among young sexually active Kenyan men, we conducted a cross-sectional assessment of lifetime sexual histories from a sub-sample of men enrolled in a clinical trial of male circumcision. 7913 partnerships of 1370 men were analyzed. 262 men (19%) reported never, 1018 (74%) sometimes and 92 (7%) always using a condom with their partners. Condoms were always used in 2672 (34%) of the total relationships—212 (70%) of the relationships with sex workers, 1643 (40%) of the casual and 817 (23%) of the regular/marital relationships. Factors influencing condom use varied significantly by partner type, suggesting that HIV prevention messages promoting condom use with higher-risk partners have achieved a moderate level of acceptance. However, in populations of young, single men in generalized epidemic settings, interventions should promote consistent condom use in all sexual encounters, independently of partner type and characteristics.
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Bailey, R. C., Moses, S., Parker, C. B., Agot, K., Maclean, I., Krieger, J. N., et al. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet, 369(9562), 643–656. doi:10.1016/S0140-6736(07)60312-2.
Bajos, N., Ducot, B., Spencer, B., & Spira, A. (1997). Sexual risk-taking, socio-sexual biographies and sexual interaction: Elements of the French national survey on sexual behavior. Social Science and Medicine, 44, 25–40. doi:10.1016/S0277-9536(96)00091-3.
Benefo, K. D. (2004). Are partner and relationship characteristics associated with condom use in Zambian nonmarital relationships? International Family Planning Perspectives, 30(3), 118–127. doi:10.1363/3011804.
Bunnell, R., Opio, A., Musinguzi, J., Kirungi, W., Ekwaru, P., Mishra, V., et al. (2008). HIV transmission risk behavior among HIV-infected adults in Uganda: Results of a nationally representative survey. AIDS (London, England), 22(5), 617–624.
Carey, M. P., Carey, K. B., Maisto, S. A., Gordon, C. M., & Weinhardt, L. S. (2001). Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: Continued development and psychometric evaluation with psychiatric outpatients. International Journal of STD and AIDS, 12(6), 365–375. doi:10.1258/0956462011923309.
Chatterjee, N., Hosain, G. M., & Williams, S. (2006). Condom use with steady and casual partners in inner city African-American communities. Sexually Transmitted Infections, 82(3), 238–242. doi:10.1136/sti.2005.018259.
Cooper, M. L., & Orcutt, H. K. (2000). Alcohol use, condom use and partner type among heterosexual adolescents and young adults. Journal of Studies on Alcohol, 61(3), 413–419.
de Visser, R., & Smith, A. (2001). Relationship between sexual partners influences rates and correlates of condom use. AIDS Education and Prevention, 13(5), 413–427. doi:10.1521/aeap.13.5.413.24146.
de Visser, R. O., Smith, A. M. A., Rissel, C. E., Richters, J., & Grulich, A. E. (2003). Sex in Australia: Safer sex and condom use among a representative sample of adults. Australian and New Zealand Journal of Public Health, 27(2), 223–229. doi:10.1111/j.1467-842X.2003.tb00812.x.
Douthwaite, M. R., & Saroun, L. (2006). Sexual behaviour and condom use among unmarried young men in Cambodia. AIDS Care, 18(5), 505–513. doi:10.1080/13548500500221537.
Ferguson, A., Pere, M., Morris, C., Ngugi, E., & Moses, S. (2004). Sexual patterning and condom use among a group of HIV vulnerable men in Thika, Kenya. Sexually Transmitted Infections, 80(6), 435–439. doi:10.1136/sti.2004.010462.
Ford, K., Sohn, W., & Lepkowski, J. (2002). American adolescents: Sexual mixing patterns, bridge partners, and concurrency. Sexually Transmitted Diseases, 29(1), 13–19. doi:10.1097/00007435-200201000-00003.
Ford, N., & Koetsawang, S. (1999). A pragmatic intervention to promote condom use by female sex workers in Thailand. Bulletin of the World Health Organization, 77(11), 888–894.
Glynn, J. R., Carael, M., Auvert, B., Kahindo, M., Chege, J., Musonda, R., et al. (2001). Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia. AIDS (London, England), 15(Suppl 4), S51–S60. doi:10.1097/00002030-200108004-00006.
Glynn, J. R., Carael, M., Buve, A., Musonda, R. M., & Kahindo, M. (2003). HIV risk in relation to marriage in areas with high prevalence of HIV infection. Journal of Acquired Immune Deficiency Syndromes, 33(4), 526–535.
Halperin, D. T., & Epstein, H. (2004). Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: Implications for prevention. Lancet, 364(9428), 4–6. doi:10.1016/S0140-6736(04)16606-3.
Hearst, N., & Chen, S. (2004). Condom promotion for AIDS prevention in the developing world: Is it working? Studies in Family Planning, 35(1), 39–48. doi:10.1111/j.1728-4465.2004.00004.x.
Hounton, S. H., Carabin, H., & Henderson, N. J. (2005). Towards an understanding of barriers to condom use in rural Benin using the Health Belief Model: A cross sectional survey. BMC Public Health, 5, 8. doi:10.1186/1471-2458-5-8.
Hu, F. B., Goldberg, J., Hedeker, D., Flay, B. R., & Pentz, M. A. (1998). Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes. American Journal of Epidemiology, 147(7), 694–703.
Kelley, S. S., Borawski, E. A., Flocke, S. A., & Keen, K. J. (2003). The role of sequential and concurrent sexual relationships in the risk of sexually transmitted diseases among adolescents. The Journal of Adolescent Health, 32(4), 296–305. doi:10.1016/S1054-139X(02)00710-3.
Lagarde, E., Carael, M., Glynn, J. R., Kanhonou, L., Abega, S. C., Kahindo, M., et al. (2001). Educational level is associated with condom use within non-spousal partnerships in four cities of sub-Saharan Africa. AIDS (London, England), 15(11), 1399–1408.
Lescano, C. M., Vazquez, E. A., Brown, L. K., Litvin, E. B., & Pugatch, D. (2006). Condom use with “casual” and “main” partners: What’s in a name? Journal of Adolescent Health, 39(3), 443.e1–443.e7.
Levine, W. C., Revollo, R., Kaune, V., Vega, J., Tinajeros, F., Garnica, M., et al. (1998). Decline in sexually transmitted disease prevalence in female Bolivian sex workers: Impact of an HIV prevention project. AIDS (London, England), 12(14), 1899–1906. doi:10.1097/00002030-199814000-00022.
Luke, N. (2005). Confronting the ‘sugar daddy’ stereotype: Age and economic asymmetries and risky sexual behavior in urban Kenya. International Family Planning Perspectives, 31(1), 6–14. doi:10.1363/3100605.
Macaluso, M., Demand, M. J., Artz, L. M., & Hook, E. W., III (2000). Partner type and condom use. AIDS (London, England), 14(5), 537–546. doi:10.1097/00002030-200003310-00009.
Maharaj, P., & Cleland, J. (2005). Risk perception and condom use among married or cohabiting couples in KwaZulu-Natal, South Africa. International Family Planning Perspectives, 31(1), 24–29. doi:10.1363/3102405.
Manhart, L. E., Aral, S. O., Holmes, K. K., & Foxman, B. (2002). Sex partner concurrency: Measurement, prevalence, and correlates among urban 18–39-year-olds. Sexually Transmitted Diseases, 29(3), 133–143. doi:10.1097/00007435-200203000-00003.
Meda, N., Ndoye, I., M’Boup, S., Wade, A., Ndiaye, S., Niang, C., et al. (1999). Low and stable HIV infection rates in Senegal: Natural course of the epidemic or evidence for success of prevention? AIDS (London, England), 13(11), 1397–1405. doi:10.1097/00002030-199907300-00018.
Monitoring the AIDS Pandemic (MAP) network. (2002). The status and trends of the HIV/AIDS epidemics in the world. Barcelona, Spain: MAP Provisional Report.
Murray, L., Moreno, L., Rosario, S., Ellen, J., Sweat, M., & Kerrigan, D. (2007). The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS and Behavior, 11(3), 463–470. doi:10.1007/s10461-006-9184-5.
Ngugi, E. N., Wilson, D., Sebstad, J., Plummer, F. A., & Moses, S. (1996). Focused peer-mediated educational programs among female sex workers to reduce sexually transmitted disease and human immunodeficiency virus transmission in Kenya and Zimbabwe. The Journal of Infectious Diseases, 174(Suppl 2), S240–S247.
Noar, S. M., Cole, C., & Carlyle, K. (2006). Condom use measurement in 56 studies of sexual risk behavior: Review and recommendations. Archives of Sexual Behavior, 35(3), 327–345. doi:10.1007/s10508-006-9028-4.
Noar, S. M., Zimmerman, R. S., & Atwood, K. A. (2004). Safer sex and sexually transmitted infections from a relationship perspective. In J. H. Harvey, A. Wenzel & S. Sprecher (Eds.), Handbook of sexuality in close relationships (pp. 519–544). Mahwah, NJ: Erlbaum.
Norman, L. R. (2003). Predictors of consistent condom use: A hierarchical analysis of adults from Kenya, Tanzania and Trinidad. International Journal of STD and AIDS, 14(9), 584–590. doi:10.1258/095646203322301022.
Outwater, A., Nkya, L., Lwihula, G., O’Connor, P., Leshabari, M., Nguma, J., et al. (2000). Patterns of partnership and condom use in two communities of female sex workers in Tanzania. The Journal of the Association of Nurses in AIDS Care, 11(4), 46–54. doi:10.1016/S1055-3290(06)60395-6.
Plummer, M. L., Wight, D., Wamoyi, J., Mshana, G., Hayes, R. J., & Ross, D. A. (2006). Farming with your hoe in a sack: Condom attitudes, access, and use in rural Tanzania. Studies in Family Planning, 37(1), 29–40. doi:10.1111/j.1728-4465.2006.00081.x.
Pool, R., Kamali, A., & Whitworth, J. A. (2006). Understanding sexual behaviour change in rural southwest Uganda: A multi-method study. AIDS Care, 18(5), 479–488. doi:10.1080/09540120500221639.
Sheeran, P., & Abraham, C. (1994). Measurement of condom use in 72 studies of HIV-preventive behaviour: A critical review. Patient Education and Counseling, 24(3), 199–216. doi:10.1016/0738-3991(94)90065-5.
Sheeran, P., Abraham, C., & Orbell, S. (1999). Psychosocial correlates of heterosexual condom use: A meta-analysis. Psychological Bulletin, 125(1), 90–132. doi:10.1037/0033-2909.125.1.90.
Smith, D. J. (2007). Modern marriage, men’s extramarital sex, and HIV risk in southeastern Nigeria. American Journal of Public Health, 97(6), 997–1005. doi:10.2105/AJPH.2006.088583.
Steiner, M. J., Taylor, D. J., Feldblum, P. J., & Wheeless, A. J. (2000). How well do male latex condoms work? Pregnancy outcome during one menstrual cycle of use. Contraception, 62(6), 315–319. doi:10.1016/S0010-7824(00)00185-2.
Stoner, B. P., Whittington, W. L., Aral, S. O., Hughes, J. P., Handsfield, H. H., & Holmes, K. K. (2003). Avoiding risky sex partners: Perception of partners’ risks v partners’ self reported risks. Sexually Transmitted Infections, 79(3), 197–201. doi:10.1136/sti.79.3.197.
Sunmola, A. M. (2005). Evaluating the sexual behaviour, barriers to condom use and its actual use by university students in Nigeria. AIDS Care, 17(4), 457–465.
Thomsen, S., Stalker, M., & Toroitich-Ruto, C. (2004). Fifty ways to leave your rubber: How men in Mombasa rationalise unsafe sex. Sexually Transmitted Infections, 80(6), 430–434. doi:10.1136/sti.2004.010421.
UNAIDS. (2006). Report on the global AIDS epidemic 2006. Switzerland: Geneva.
Van Rossem, R., Meekers, D., & Akinyemi, Z. (2001). Consistent condom use with different types of partners: Evidence from two Nigerian surveys. AIDS Education and Prevention, 13(3), 252–267. doi:10.1521/aeap.13.3.252.19745.
Acknowledgements
We thank the participants, without whom this work would not have been possible, and Bob Ogollah, Kevine Kamolloh, and the entire UNIM Project staff for their assistance in data collection and recruitment. This research was supported by Award Number U01AI050440 from the National Institute of Allergy and Infectious Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health. Additionally, S. Moses was supported by a CIHR Investigator Award.
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Westercamp, N., Mattson, C.L., Madonia, M. et al. Determinants of Consistent Condom Use Vary by Partner Type among Young Men in Kisumu, Kenya: A Multi-level Data Analysis. AIDS Behav 14, 949–959 (2010). https://doi.org/10.1007/s10461-008-9458-1
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DOI: https://doi.org/10.1007/s10461-008-9458-1