Why don't urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults.
BACKGROUND
Zambia experiences high unmet need for family planning and high rates of HIV, particularly among youth. While male condoms are widely available and 95% of adults have heard of them, self-reported use in the past 12 months is low among young adults (45%). This study describes factors associated with non-use of male condoms among urban young adults in Zambia.


METHODS
A household cross-sectional survey in four urban districts was conducted from November 2015 to January 2016 among sexually active young adults ages 18-24 years. A random walk strategy was implemented in urban areas; eligible, enrolled participants were administered a survey on household characteristics, health access, and knowledge, attitudes and practices related to contraception. Relative risk regression models were built to determine factors associated with the decision to not use a male condom (non-use) at most recent sexual intercourse.


RESULTS
A total of 2,388 individuals were interviewed; 69% were female, 35% were married, and average lifetime sex partners was 3.45 (SD±6.15). Non-use of male condoms was 59% at most recent sexual intercourse. In a multivariate model, women were more likely to report non-use of a male condom compared with men (aRR = 1.24 [95% CI: 1.11, 1.38]), married individuals were more likely to report non-use compared with unmarried individuals (aRR = 1.59 [1.46, 1.73]), and those residing in the highest poverty wards were more likely to report non-use compared with those in the lowest poverty wards (aRR = 1.31 [1.16, 1.48]). Those with more negative perceptions of male condom use were 6% more likely to report non-use (aRR = 1.06 [1.03, 1.09]). Discussion regarding contraception with a partner decreased non-use 13% (aRR = 0.87 [0.80, 0.95]) and agreement regarding male condom use with a partner decreased non-use 16% (aRR = 0.84 [0.77, 0.91)]).


CONCLUSIONS
Non-use of male condoms is high among young, married adults, particularly women, who may be interested in contraception for family planning but remain at risk of STI infection. Effective marketing strategy of dual protection methods to this population is critical.
Research Department, Innovations for Poverty Action, New Haven, Connecticut, United States of America.
Jessie
J
Pinchoff
Research Department, Innovations for Poverty Action, New Haven, Connecticut, United States of America.
Christopher B
CB
Boyer
Society for Family Health, Lusaka, Zambia.
Namuunda
N
Mutombo
Innovations for Poverty Action Zambia, Jesmondine, Lusaka, Zambia.
Rachna Nag
RN
Chowdhuri
Poverty, Gender and Youth Program, Population Council, One Dag Hammarskjold Plaza, New York, New York, United States of America.
Thoai D
TD
Ngo
D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003267:Contraception / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008393:Marriage / Q000523:psychology; D011203:Poverty; D012309:Risk-Taking; D021841:Safe Sex / Q000523:psychology; D012736:Sex Education / Q000379:methods; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult; D015024:Zambia