Is 80% a passing grade? Meanings attached to condom use in an abstinence-plus HIV prevention programme in South Africa.
This study represents the first qualitative exploration of how condoms are perceived by at-risk youth, their parents, their teachers and HIV prevention programme staff in an abstinence-plus HIV prevention programme. Behavioural interventions for HIV prevention with youth may be divided into three categories, each with a different approach to condoms: abstinence-only, abstinence-plus and comprehensive approaches. Research has highlighted the limitations of abstinence-only approaches and the emergence of early support for abstinence-plus interventions as HIV prevention strategies. Furthermore, research consistently demonstrates that condoms are socially mediated, reflecting diverse norms. However, there is a gap in the literature in terms of how condom use is framed, understood and represented by those delivering and receiving an abstinence-plus programme. This is critically important because advocates of a comprehensive approach to HIV prevention have flagged concern with the degree to which abstinence-plus programming may undermine confidence in condom use. Therefore, this study analyses meanings attached to condom use by stakeholders in an abstinence-plus HIV prevention programme in South Africa. Results demonstrate diverse meanings attached to condom use, including: condoms as second best to abstinence; condoms as a gendered response to HIV; condoms as a source of mockery; condoms as futile in a high-prevalence setting; condoms as part of conspiracy beliefs along racial and colonial lines; and, condoms as popular in HIV prevention because they can be counted. These findings have particular bearing for abstinence-plus HIV prevention programmes, which face the double challenge of (1) engaging with condom promotion in a way that takes into account their diverse social meanings, and (2) promoting condoms within their hierarchical framework of options in a way that does not inadvertently discourage their use.
Department of Physical Therapy, University of Toronto, ON, Canada. stephanie.nixon@utoronto.ca
Stephanie A
SA
Nixon
Clara
C
Rubincam
Marisa
M
Casale
Sarah
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Flicker
D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data*; D005178:Faculty; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D010290:Parents; D036301:Qualitative Research; D021841:Safe Sex / Q000523:psychology*; D012746:Sexual Abstinence / Q000523:psychology*; D013019:South Africa; D055815:Young Adult