Disappointment over efforts to slow the spread of HIV in Africa may be unfounded, research suggests. Analysis of data from 18 African countries, covering 132,800 single women aged 15 to 24, shows that their behaviour has changed. The results support efforts to promote condoms for contraception, not just HIV prevention.

Researchers based at the London School of Hygiene and Tropical Medicine (UK) and the World Health Organisation chose to look at this group of women because:

• their behaviour, and that of young men, will shape the epidemic in the coming decade
• they make up around a fifth of all women aged 15 to 49 in these countries
• sexually active single people are at higher risk of HIV than those who are married
• patterns of sexual behaviour set at a young age probably last into adulthood.

The results showed that between 1993 and 2001 the percentage of women who said they were virgins changed little. During the same period:

• The percentage of sexually-experienced women who said they had no intercourse in the last three months rose significantly in seven countries. The increase was more than ten percent in five of these and the median (average) for all 18 countries increased from 43.8 percent to 49.2 percent.
• Use of condoms for pregnancy prevention rose significantly in 13 countries and the median proportion increased from 5.3 percent to 18.8 percent. The rise in condom use was more than ten percent in nine countries.
• In 13 countries women were also questioned about condom use at most recent intercourse, regardless of the motive (i.e. pregnancy- versus disease-prevention). In these countries, condom use rose from a median of 19.3 percent to 28.4 percent, but trends were not related to severity of national HIV epidemics.
• Over half (58.5 percent) of those who used a condom at most recent intercourse were motivated at least partly by a wish to avoid pregnancy.
• In 15 countries, most women who use condoms for pregnancy prevention buy them chiefly from pharmacies and shops.

Very few single women want to become pregnant, so the need for contraception is high. Overall contraceptive use has not increased much but there is a shift from traditional methods towards condoms, rather than modern non-barrier methods, such as oral contraceptives. This rise in condom use might be due to greater awareness of the method and to social marketing campaigns which have improved their commercial availability.

The growth of condoms as a contraceptive has an extra benefit through their protection against HIV. It means that programmes promoting family planning and HIV prevention have common interests. A young woman might find it easier to negotiate use of condoms to prevent pregnancy than to protect against HIV.

The researchers conclude that:

• the sense of failure around HIV prevention efforts in Africa is unjustified. Investments in condom promotion have had an important effect, at least for young single women
• behaviour change on a large scale takes time. First, new messages must become embedded in local social networks
• HIV prevention programmes could promote condoms more effectively through an emphasis on preventing pregnancy rather than sexually-transmitted infections.

Source(s):
‘Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data’, The Lancet 368: 1788-1793, by John Cleland and Mohamed Ali, 2006 Full document.
For further reading see also: 'Trends in protective behaviour among single vs. married young women in sub-Saharan Africa: The big picture', Reproductive Health Matters, 14(28), pages 17-22, by John Cleland, Mohamed Ali and Iqbal Shah, 2006
For further reading see also: 'Condoms become the norm in the sexual culture of college students in Durban, South Africa', Reproductive Health Matters 14(28), pages 104-112, by Pranitha Maharaj and John Cleland, 2006

id21 Research Highlight: 9 March 2007

Further Information:
John Cleland
Centre for Population Studies
London School of Hygiene and Tropical Medicine
49-51 Bedford Square
London
WC1B 3DP
UK

Tel: +44 (0) 20 72994621
Fax: +44 (0) 20 72994637
Contact the contributor: john.cleland@lshtm.ac.uk

Centre for Population Studies, London School of Hygiene and Tropical Medicine, UK

World Health Organization (WHO)

Other related links:
'Barriers to adolescent contraceptive use in South Africa'

'Condoms versus the pill: HIV prevention and effective contraception for married couples'

'Putting it on – what makes young people in Madagascar use condoms?'

'What’s the use? Condom use among youth in urban Cameroon'

'Rich rewards - condom use and HIV rates among the wealthy in Zambia'