Abstract
Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community’s perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including “disgust” for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users’ needs.
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Acknowledgements
We would like to thank the Human Sciences Research Council for their guidance through the design and implementation of this study. We would also like to thank Drs. Leickness Simbayi and Allanise Cloete for their invaluable mentorship and guidance during the conduct of this research project. We would also like to thank all of our community partners in South Africa, including Nati and the many community health workers for their tireless dedication towards the eradication of HIV and their support of our research. Further, we would like to thank our participants, community members of Cape Town, for sharing their narratives with us. We would also like to thank Dr. Sara St. George for her guidance on qualitative methods.
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This work was supported by the Emory University Global Health Initiative, Global Elimination of Maternal Mortality from Abortion (GEMMA) Fund, National Institute on Drug Abuse (awards #K99DA041494, #R00DA041494), the National Institute on Mental Health (award #R01MH100021), and the Emory University Center for AIDS Research Adelante.
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In accordance with the CRediT taxonomy, the authors contributed towards the article as follows. CHS contributed towards this article through conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing—original draft preparation, writing—review and editing, project administration, and funding acquisition. KP contributed towards this article through conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing—original draft preparation, writing—review and editing, project administration, and funding acquisition. MK contributed towards this article through resources, writing—original draft preparation, writing—review and editing, and funding acquisition. RR contributed towards this article through conceptualization, methodology, software, validation, resources, writing—review and editing, and supervision. AS contributed towards this article through conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing—original draft preparation, writing—review and editing, supervision, project administration, and funding acquisition.
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The Emory University Institutional Review Board (Study No.: IRB IRB00066402) and the Human Sciences Research Council Research Ethics Committee (ID 10350) provided ethical review and clearance to conduct the study. The City of Cape Town granted further permission to conduct research at four City of Cape Town public health clinics—additional information can be found above and elsewhere (Baker et al., 2018). The authors wrote this publication in accordance with the COnsolidated Criteria for REporting Qualitative research (COREQ) checklist, to report important aspects of the study (Tong, Sainsbury, & Craig, 2007). All procedures performed in studies involving human participants were in accordance with the ethical standards of Emory University Institutional Review Board, the Human Sciences Research Council Research Ethics Committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Shrader, CH., Peters Jefferson, K., Kanamori, M. et al. “I’d Rather Use a Refuse Bag:” A Qualitative Exploration of a South African Community’s Perceptions of Government-Provided Condoms and Participant-Preferred Solutions. Arch Sex Behav 50, 615–627 (2021). https://doi.org/10.1007/s10508-020-01701-2
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DOI: https://doi.org/10.1007/s10508-020-01701-2