Citation
Broderick, Kathryn; Aristide, Christine; Bullington, Brooke W.; Mwanga-Amumpaire, Juliet; Downs, Jennifer A.; & Sundararajan, Radhika (2023). Stigma of Infidelity Associated with Condom Use Explains Low Rates of Condom Uptake: Qualitative Data from Uganda and Tanzania. Reproductive Health, 20(1), 12. PMCID: PMC9832812Abstract
Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one's partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of "failure" to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied "ABC" HIV prevention approach, a public health messaging strategy that described A-abstinence, B-be faithful, and C-use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).Condoms are used to prevent HIV infection. Even though public health organizations have encouraged people to use condoms, many people in sub-Saharan Africa do not, especially in sexual encounters with someone that they are living with or married to. In this study, we wanted to understand the reasons that people were not using condoms. Between 2016 and 2019, we spoke with individuals in Uganda in one-on-one interviews about HIV prevention and testing and with focus groups in Tanzania about family planning. We analyzed transcripts of these conversations to find common themes about people’s impressions of condom use. We learned that many of our participants believed that abstaining from sex and being faithful were the best ways to prevent HIV infection, but that they were not realistic strategies in the long term. Condoms were thought of as a useful tool for prevention when you “fail” at abstinence and monogamy. They were linked with being unfaithful, so people did not feel comfortable suggesting their use in committed relationships. These findings show that the “ABC” strategy for HIV prevention education may be continuing to make people think negatively about condom use. This strategy presented a tiered approach to HIV prevention, telling people it was best to (A) abstain, (B) be faithful to one’s partners, and (C) use a condom. In order to increase engagement with HIV prevention, public health messages need to acknowledge the negative associations between condoms and infidelity.
URL
http://dx.doi.org/10.1186/s12978-023-01563-6Reference Type
Journal ArticleYear Published
2023Journal Title
Reproductive HealthAuthor(s)
Broderick, KathrynAristide, Christine
Bullington, Brooke W.
Mwanga-Amumpaire, Juliet
Downs, Jennifer A.
Sundararajan, Radhika
Article Type
RegularPMCID
PMC9832812Continent/Country
UgandaTanzania