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Effective use and barriers to effective use of male condoms among HIV negative people in Manicaland, Zimbabwe: An HIV Prevention Cascade analysis

Louisa Moorhouse, Imperial College London
Robin Schaefer, Imperial College London
Jeff Eaton, Imperial College London
Constance Nyamukapa, Imperial College London
Ranjeeta Thomas, London School of Economics
Morten Skovdal, University of Copenhagen
Mike Pickles, Imperial College London
Rufurwokuda Maswera, Biomedical Research and Training Institute
Tawanda Dadirai, Biomedical Research and Training Institute
Timothy Hallett, Imperial College London
Simon Gregson, Imperial College London

Many sub-Saharan African countries are failing to meet international targets for reducing HIV incidence despite availability of efficacious prevention methods including condoms. HIV-negative individuals engaging in sexual risk-behaviours are likely to contribute to HIV acquisition and transmission and are a priority population for prevention. Data collected in a bespoke cross-sectional general-population pilot study in Manicaland, Zimbabwe (2018-19) were used to measure proportions with recent HIV risk behaviours and populate an HIV prevention cascade (HPC) framework. Logistic regression was used to estimate associations between barriers hypothesised in the HPC framework and condom use. 37% of sexually-active females and 65% of sexually-active males reported =1 HIV risk-behaviour. Condom use was higher in men (42%) than women (19%). Lack of future risk perception was the biggest barrier to condom use in men (OR=0.33;0.23-0.50). Lack of self-efficacy to use condoms was the biggest barrier in females (OR=0.15;0.11-0.22). Lack of social acceptability was a barrier in men (OR=0.44;0.30-0.66) and women (OR=0.47;0.31-0.71). Interventions, in HIV-negative adults engaging in risk behaviours, that focus on HIV risk perception, the social acceptability of condoms and strengthening self-efficacy to negotiate condom use with sexual partners could increase effective use of condoms and accelerate reductions in HIV incidence in east Zimbabwe.

Keywords: Family planning and contraception, Sexual and Reproductive Health and Rights

See extended abstract.

  Presented in Session 19. Men as Part of the Sexual and Reproductive Health Equation