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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).

Titel:	Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania.
Autor/in / Beteiligte Person:	Broderick, K ; Aristide, C ; Bullington, BW ; Mwanga-Amumpaire, J ; Downs, JA ; Sundararajan, R
Link:	Full Text Finder (Volltext)
Zeitschrift:	Reproductive health, Jg. 20 (2023-01-11), Heft 1, S. 12
Veröffentlichung:	[London] : BioMed Central, 2004-, 2023
Medientyp:	academicJournal
ISSN:	1742-4755 (electronic)
DOI:	10.1186/s12978-023-01563-6
Schlagwort:	Adult Male Humans Condoms Sexual Behavior Tanzania Uganda Health Knowledge, Attitudes, Practice HIV Infections epidemiology Acquired Immunodeficiency Syndrome prevention & control
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Reprod Health] 2023 Jan 11; Vol. 20 (1), pp. 12. <i>Date of Electronic Publication: </i>2023 Jan 11. MeSH Terms: HIV Infections* / epidemiology ; Acquired Immunodeficiency Syndrome* / prevention & control ; Adult ; Male ; Humans ; Condoms ; Sexual Behavior ; Tanzania ; Uganda ; Health Knowledge, Attitudes, Practice References: Lancet. 2008 Jun 28;371(9631):2183-91. (PMID: 18586173) ; AIDS Behav. 2012 May;16(4):1044-53. (PMID: 22307821) ; Sex Transm Infect. 2007 Dec;83(7):510-6. (PMID: 17932124) ; J Adolesc Health. 2017 Sep;61(3):273-280. (PMID: 28842065) ; Glob Health Action. 2017 Jan - Dec;10(sup2):1341597. (PMID: 28678650) ; Science. 2004 Apr 30;304(5671):714-8. (PMID: 15118157) ; AIDS. 2014 Jun 19;28(10):1509-19. (PMID: 24809629) ; AIDS Care. 2011 Sep;23(9):1171-6. (PMID: 21476146) ; Afr Health Sci. 2003 Dec;3(3):107-16. (PMID: 14676715) ; Reprod Health. 2022 Jan 21;19(1):18. (PMID: 35062968) ; Soc Sci Med. 2014 Sep;116:169-77. (PMID: 25016170) ; World Health Popul. 2011;12(4):35-47. (PMID: 21677533) ; Postgrad Med J. 2005 Oct;81(960):625-8. (PMID: 16210457) ; BMC Med Res Methodol. 2013 Sep 18;13:117. (PMID: 24047204) ; Qual Health Res. 2005 Nov;15(9):1277-88. (PMID: 16204405) ; J Int AIDS Soc. 2022 Mar;25(3):e25894. (PMID: 35324081) ; Soc Sci Med. 1997 May;44(9):1303-12. (PMID: 9141163) ; PLoS One. 2021 Feb 17;16(2):e0246717. (PMID: 33596216) ; Glob Health Action. 2016 Sep 14;9:32326. (PMID: 27633036) ; Open AIDS J. 2016 Apr 08;10:34-48. (PMID: 27347270) ; PLoS One. 2018 Dec 7;13(12):e0208167. (PMID: 30532210) ; AIDS Care. 2005 Feb;17(2):153-65. (PMID: 15763711) ; BMJ. 2004 Apr 10;328(7444):891-3. (PMID: 15073076) ; PLoS Med. 2006 Sep;3(9):e379. (PMID: 17002505) ; Soc Sci Med. 2007 Mar;64(5):1102-15. (PMID: 17240504) ; BMC Womens Health. 2019 Jul 22;19(1):99. (PMID: 31331306) ; BMC Public Health. 2012 Sep 14;12:788. (PMID: 22978613) ; Contraception. 2023 Jan;117:13-21. (PMID: 36115610) Grant Information: K23MH111409 United States MH NIMH NIH HHS; T32 HD007168 United States HD NICHD NIH HHS; P2C HD050924 United States HD NICHD NIH HHS Contributed Indexing: Keywords: Eastern Africa; External condom; HIV prevention; HIV/AIDS; Male condom ; Local Abstract: [plain-language-summary] 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. Entry Date(s): Date Created: 20230111 Date Completed: 20230113 Latest Revision: 20231221 Update Code: 20231221 PubMed Central ID: PMC9832812

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Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania.