Skip to main content

Advertisement

SpringerLink
Log in

Gender, Sexual Self-Efficacy and Consistent Condom Use Among Adolescents Living in the HIV Hyper-Endemic Setting of Soweto, South Africa

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Within HIV-endemic settings, few studies have examined gendered associations between sexual self-efficacy (SSE), one’s confidence or perceived control over sexual behavior, and uptake of HIV prevention behaviors. Using cross-sectional survey data from 417 sexually-experienced adolescents (aged 14–19, median age = 18, 60% female) in Soweto, South Africa, we measured SSE using a 6-item scale (range:0–6) with ‘high-SSE’ = score > 3 (study alpha = 0.75). Gender-stratified logistic regression models assessed associations between high-SSE and lifetime consistent condom use. A higher proportion of women reported high-SSE (68.7%) than men (49.5%, p < 0.001). We observed no difference in reported consistent condom use by gender (45.5% among women, 45.8% among men; p = 0.943). In confounder models, high-SSE was associated with consistent condom use among men (aOR = 3.51, 95%CI = 1.86–6.64), but not women (aOR = 1.43, 95%CI = 0.74–2.77). Findings highlight that individual-level psychosocial factors are insufficient for understanding condom use and must be considered alongside the relational, social, and structural environments within which young women navigate their sexual lives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. UNAIDS, The African Union. Empower young women and adolescent girls: Fast-tracking the end of the AIDS epidemic in Africa. Geneva, Switzerland Joint United Nations Programme on HIV/AIDS (UNAIDS) 2015.

  2. Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town2014.

  3. Taylor M, Dlamini SB, Nyawo N, Huver R, Jinabhai CC, de Vries H. Reasons for inconsistent condom use by rural South African high school students. Acta Paediatr. 2007;96(2):287–91.

    Article  CAS  PubMed  Google Scholar 

  4. Matseke G, Peltzer K, Mchunu G, Louw J. Correlates of condom use among male and female aged 18–24 years in South Africa. Gender & Behaviour. 2012;2012(10):4627–44.

    Google Scholar 

  5. Bandura A. Perceived self-efficacy in the exercise of control over AIDS infection. Evaluation and Program Planning. 1990;13:9–17.

    Article  Google Scholar 

  6. 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. Am J Public Health. 2007;97(7):1241–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Adedimeji AA, Heard NJ, Odutolu O, Omololu FO. Social factors, social support and condom use behavior among young urban slum inhabitants in southwest Nigeria. East Afr J Public Health. 2008;5(3):215–22.

    PubMed  Google Scholar 

  8. Bogale GW, Boer H, Seydel ER. Effects of a theory-based audio HIV/AIDS intervention for illiterate rural females in Amhara. Ethiopia. AIDS Educ Prev. 2011;23(1):25–37.

    Article  PubMed  Google Scholar 

  9. Rijsdijk LE, Bos AE, Ruiter RA, Leerlooijer JN, de Haas B, Schaalma HP. The World Starts With Me: a multilevel evaluation of a comprehensive sex education programme targeting adolescents in Uganda. BMC Public Health. 2011;11:334.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Maticka-Tyndale E, Wildish J, Gichuru M. Quasi-experimental evaluation of a national primary school HIV intervention in Kenya. Eval Program Plann. 2007;30(2):172–86.

    Article  PubMed  Google Scholar 

  11. Cupp PK, Zimmerman RS, Bhana A, et al. Combining and adapting American school-based alcohol and HIV prevention programmes in South Africa: The HAPS project. Vulnerable Children and Youth Studies. 2008;3(2):134–42.

    Article  Google Scholar 

  12. Harrison A, Newell ML, Imrie J, Hoddinott G. HIV prevention for South African youth: which interventions work? A systematic review of current evidence. BMC Public Health. 2010;10:102.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Karim AM, Magnani RJ, Morgan GT, Bond KC. Reproductive health risk and protective factors among unmarried youth in Ghana. Int Fam Plan Perspect. 2003;29(1):14–24.

    Article  PubMed  Google Scholar 

  14. Babalola S. Gender differences in the factors influencing consistent condom use among young people in Tanzania. Int J Adolesc Med Health. Apr-Jun. 2006;18(2):287–98.

    Google Scholar 

  15. Sayles JN, Pettifor A, Wong MD, et al. Factors associated with self-efficacy for condom use and sexual negotiation among South african youth. J Acquir Immune Defic Syndr. 2006;43(2):226–33.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Guiella G, Madise NJ. HIV/AIDS and sexual-risk behaviors among adolescents: factors influencing the use of condoms in Burkina Faso. Afr J Reprod Health. 2007;11(3):182–96.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Miller CL, Nkala B, Closson K, et al. The Botsha Bophelo Adolescent Health Study: a profile of adolescents in Soweto, South Africa. Southern African Journal of HIV Medicine. 2017;18(1):a731.

    Article  Google Scholar 

  18. Nkala B, Khunwane M, Dietrich J, et al. Kganya Motsha Adolescent Centre: a model for adolescent friendly HIV management and reproductive health for adolescents in Soweto. South Africa. AIDS Care. 2015;27(6):697–702.

    Article  PubMed  Google Scholar 

  19. Basen-Engquist K. Evaluation of a theory-based HIV prevention intervention for college students. AIDS Educ Prev. 1994;6(5):412–24.

    CAS  PubMed  Google Scholar 

  20. Hanna KM. An adolescent and young adult condom self-efficacy scale. J Pediatr Nurs. 1999;14(1):59–66.

    Article  CAS  PubMed  Google Scholar 

  21. Louw J, Peltzer K, Chirinda W. Correlates of HIV risk reduction self-efficacy among youth in South Africa. Scientific World J. 2012;2012:817315.

    Article  Google Scholar 

  22. Hanass-Hancock J. Tangible skill building and HIV youth prevention intervention in rural South Africa. African J AIDS Res. 2014;13(3):229–35.

    Article  Google Scholar 

  23. Radimer KL, Olson CM, Campbell CC. Development of indicators to assess hunger. J Nutr. 1990;120:1544–6.

    Article  PubMed  Google Scholar 

  24. Kendall A, Olson CM, Edward A. Frongillo J. Validation of the Radimer/Cornell Measures of HUnger and Food Security. J Nutr. 1995;125:2793–801.

    CAS  PubMed  Google Scholar 

  25. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  26. Chabrol H, Montovany A, Chouicha K, Duconge E. Study of the CES-D on a sample of 1,953 adolescent students. L’Encephale. Sep-Oct. 2002;28(5 Pt 1):429–32.

    CAS  Google Scholar 

  27. Muula AS. HIV Infection and AIDS Among Young Women in South Africa. Croatian Med J. 2008;49(3):423–35.

    Article  Google Scholar 

  28. Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained high hiv incidence in young women in Southern Africa: social, behavioral, and structural factors and emerging intervention approaches. Curr HIV/AIDS Rep. 2015;12(2):207–15.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Harrison A, O’Sullivan LF, Hoffman S, Dolezal C, Morrell R. Gender role and relationship norms among young adults in South Africa: measuring the context of masculinity and HIV risk. J Urban Health. 2006;83(4):709–22.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Closson K, Dietrich JJ, Nkala B, et al. Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention. BMC Public Health. 2016;16(1):1191.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Volpe EM, Hardie TL, Cerulli C. Associations among depressive symptoms, dating violence, and relationship power in urban, adolescent girls. J Obstet Gynecol Neonatal Nurs. Jul-Aug. 2012;41(4):506–18.

    Article  Google Scholar 

  33. Batchelder AW, Gonzalez JS, Palma A, Schoenbaum E, Lounsbury DW. A Social Ecological Model of Syndemic Risk affecting Women with and At-Risk for HIV in Impoverished Urban Communities. Am J Community Psychol. 2015;56(3–4):229–40.

    Article  CAS  PubMed  Google Scholar 

  34. Jewkes R, Nduna M, Jama-Shai N, Chirwa E, Dunkle K. Understanding the relationships between gender inequitable behaviours, childhood trauma and socio-economic status in single and multiple perpetrator rape in rural south africa: structural equation modelling. PLoS ONE. 2016;11(5):e0154903.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jama Shai N, Jewkes R, Nduna M, Dunkle K. Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey. BMC Public Health. 2012;12:462.

    Article  PubMed  Google Scholar 

  36. Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med. 2003;56(1):125–34.

    Article  PubMed  Google Scholar 

  37. Otwombe KN, Dietrich J, Sikkema KJ, et al. Exposure to and experiences of violence among adolescents in lower socio-economic groups in Johannesburg. South Africa. BMC Public Health. 2015;15:450.

    Article  PubMed  Google Scholar 

  38. Jewkes R, Morrell R. Sexuality and the limits of agency among South African teenage women: theorising femininities and their connections to HIV risk practices. Soc Sci Med. 2012;74(11):1729–37.

    Article  CAS  PubMed  Google Scholar 

  39. Teitelman AM, Jemmott JB, Bellamy SL, et al. Partner Violence, Power, and Gender Differences in South African Adolescents’ HIV/Sexually Transmitted Infections Risk Behaviors. Health Psychol. 2016;35(7):751–60.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wamoyi J, Stobeanau K, Bobrova N, Abramsky T, Watts C. Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc. 2016;19(1):20992.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Aggarwal S, Berk M, Taljard L, Wilson Z. South African adolescents’ beliefs about depression. Int J Soc Psychiatry. 2016;62(2):198–200.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all of the adolescents who participated in BBAHS for their time and contributions. As well as all the research assistants and supports at the Perinatal HIV Research Unit who spent countless hours establishing the BBAHS.

Funding

BBAHS was funded by the Canadian Institutes of Health Research (CIHR), Institute for Human Development, Child and Youth Health (230513). Initial seed funding was provided by Simon Fraser University through a President Research Award to CLM.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, Canada

    Kalysha Closson, Robert S. Hogg, Cari L. Miller & Angela Kaida

  2. British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

    Kalysha Closson, Nathan J. Lachowsky, Alexis Palmer, Zishan Cui, Jason Chia & Robert S. Hogg

  3. Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Janan Janine Dietrich, Busi Nkala & Glenda Gray

  4. School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada

    Nathan J. Lachowsky

  5. Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa

    Busi Nkala

Authors
  1. Kalysha Closson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janan Janine Dietrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathan J. Lachowsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Busi Nkala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexis Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zishan Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jason Chia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert S. Hogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Glenda Gray
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cari L. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Angela Kaida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela Kaida.

Ethics declarations

Conflict of interest

AK received salary support from the Canada Research Chair program in Global Perspectives on HIV and Sexual and Reproductive Health. The funders of this project did not have any role in the study design, collection interpretation of the data, in the writing of the report or the decision to submit the article for publication. The authors have no conflict of interest to declare regarding the publication of this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Closson, K., Dietrich, J.J., Lachowsky, N.J. et al. Gender, Sexual Self-Efficacy and Consistent Condom Use Among Adolescents Living in the HIV Hyper-Endemic Setting of Soweto, South Africa. AIDS Behav 22, 671–680 (2018). https://doi.org/10.1007/s10461-017-1950-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-1950-z

Keywords

Search

Navigation