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If they know how to talk about them they will use them: Determinants of Condom Use Among Women in Mozambique

Valeriana Rufino, High Risk Group Manager, PSI/Mozambique Co-Authors: Filipe Bila, Jennifer Wheeler, Fatima Mussa, Dvora Joseph, Arild Drivdal, Brian Smith

HIV Implementer’s Meeting Namibia, June, 2009

OUTLINE

• Background and Implementation approach
• Analysis design and methods
• Determinants of condom use among women
• Way forward

BACKGROUND AND IMPLEMENTATION APPROACH

• Since 1994, PSI/Mozambique in

collaboration with the Ministry of Health and the National AIDS Council, has implemented HIV prevention programs, including condom social marketing.

• In 2008, PSI conducted a population-

based survey on HIV attitudes, knowledge and behaviors in selected districts of Gaza, Sofala and Zambézia.

• Survey used to identify the

determinants of condom use in women and men with non-marital non- cohabitating partners (NMNC) as well as primary partners.

ANALYSIS DESIGN AND METHODS

• The total sample size included 4,075 women and men

aged 15 to 35.

• 2/3 of the sample were women
• Women were over sampled to capture a sufficient

number of respondents with NMNC partners.

• The survey used a multi-stage cluster sampling design

to select households to be interviewed.

• Data was analyzed using ANOVA and logistic

regression procedures in SPSS.

Why do we focus on women?

• Condom use among women was significantly

lower than men in the study

• Women have less power to negotiate condom

use in Mozambique, hence we wanted to analyze determinants to improve women’s ability to negotiate and USE condoms

• Using results to develop targeted programs to

increase condom use among women

Focus of Analysis on Women

WHY FOCUS ON WOMEN?

USE OF MALE CONDOMS BY WOMEN

• Condom use is significantly lower with primary

partner than with NMNC partners and remains significantly lower than male reporting

• f condom use

PROVINCES NMNC PARTNERS PRIMARY PARTNERS GAZA 31% 21%* SOFALA 53% 30%* ZAMBEZIA 54% 33%*

* p<.05

DETERMINANTS OF CONDOM USE (Cont.)

• Self efficacy around condom use was the most

significant determinant of condom use for women with primary partners in all provinces.

• Strong confidence and “know how” about

condom use – including negotiation skills

• E.g.: “I am able to talk to all of my partners about

the importance of condom use even if we have already had sex”

DETERMINANTS OF MALE CONDOM USE AMONG WOMEN

DETERMINANTS OF CONDOM USE (Cont.)

• Positive attitudes towards condoms were

determinants of condom use among women with both primary and NMNC partners in all study sites.

• Disagreement with phrases such as “condoms

reduce pleasure” or “condoms are not comfortable”

• Availability of condoms was related to

condom use among women in Gaza only. DETERMINANTS OF CONDOM USE AMONG WOMEN, cont.

DETERMINANTS OF CONDOM USE (Cont.)

• Community social support was significantly

associated with condom use with both NMNC and primary partners in Sofala and Gaza.

• E.g.: “In my community, it is OK to be seen buying

condoms”

• However, men in Zambézia were more likely to use

condoms if they had support from friends

DETERMINANTS OF CONDOM USE AMONG WOMEN, cont.

CONCLUSIONS AND RECOMENDATIONS

• Improved interpersonal communication through

network of community agents, peer educators and theater groups

– Target sexually active women to improve self efficacy around condom use by providing

• pportunities to demonstrate, touch condoms and

ask questions

• Condoms are still highly stigmatized because
• f focus on HIV prevention in Mozambique,

which could be the cause of low use with primary partners or use for family planning

WAY FORWARD

WAY FORWARD, cont.

• Increase accessibility of condoms through free

distribution in partnership with local NGOs specially in Gaza Province

• Results of the study were incorporated into the

Government of Mozambique’s condom promotion strategy

• E.g. A national condom campaign will be launched in 2009 to

address self efficacy around condom use among women

• PSI has launched a male condom (Confianca) marketed

specifically for family planning with primary partners

CONCLUSIONS AND RECOMENDATIONS

• KANIMAMBO
• OBRIGADA
• THANK YOU