SI
YINQABA
HIV
PREVENTION
MODULE 3
Condom Use
N
ERCHA
Condom Use Page 1
CONTENTS
Overview
Behavioural outcomes and results
Discussion of Condom Use
3
3
4
Age-appropriate content on Condom Use
12
Age group: Under 10s
Age group: 10-14 years old
Age group: 15-19 year olds
Age group: 20-24 year olds
Age group: 25 years and older
12
14
18
26
32
Social and Environmental Outcomes
37
Page 2 Condom Use
Overview of Condoms
C
orrect and consistent condom use has been promoted in Swaziland as a
primary prevention method along with Abstain and Be Faithful (the ABC of
prevention). The limitations of the ABC approach are evident in the lack of
impact and are being addressed by taking a more nuanced, evidence-informed
approach to prevention. Abstain and Be Faithful has faced challenges in Swaziland
as most young people engage in sex very early, at the age of 18 years on average,
and only 23% of people are in a relationship that they can be faithful to. The national
strategic framework has recognised continued low levels of consistent condom use
as a driver of the epidemic. The outcome results for condom use are measurable,
time-bound targets that will be assessed to provide a precise indicator of whether
the change has occurred. The baseline figures are derived from the Swaziland
Demographic and Health Survey (SDHS) conducted in 2006-7.
Behavioural outcomes and results
•
More youth use a condom during first sex
•
% of young people aged 15-24 who report using a condom during first sex is
increased from 43.2% for women and 49.3% for men to 50% for women and
60% for men in 2011 and to 70% for both women and men by 2014
More youth use condom during sexual intercourse with non-regular partner (higher
risk sex)
•
% of young people aged 15-24 who report the use of a condom at last higher
risk sexual intercourse is increased from 62% in 2007 to 72% in 2011 and
75% by 2014
Condom Use Page 3
More condoms used by people with multiple partners
•
% of people aged 15-49 with more than one partner who report using a
condom during last sex is increased from 54.6% women and 56.2% men in
2007 to 60% for both in 2011 and 65% in 2014
More condoms used by sex workers
•
% of female sex workers reporting the use of a condom with their most
recent clients is maintained at 98% in 2014
Target groups and sub-groups
•
•
•
•
•
10-24 year olds who are not yet sexually active
15 year olds and older who are sexually active, especially those out of
school, rural dwelling and with lower education levels
People with MCPs or whose partners have MCPs
Women who have a sexual partner who is five or more years older than
them
Female sex workers with all partners [although reported condom use with
clients is high, it is much lower with non-paying partners, especially regular
ones like boyfriends and husbands]
Discussion on condom use
In Swaziland condom use does not appear to have changed much over time,
which implies that condom IEC campaigns and social marketing efforts have been
largely unsuccessful in increasing their acceptability amongst those most at risk,
or more specifically in increasing the accuracy of individual’s risk perception in
relation to long term and concurrent partnerships (see the module on Multiple
and Concurrent Partnerships). According to the SDHS, knowledge of condoms
is high: 91% of women aged 15-49 and 87% of men could cite it as a prevention
method and almost 100% know of male condoms. Knowledge is associated with
higher education level and wealth. Nearly 90% of people know where to get male
condoms, but less than half of those women and only a third of men who know of
female condoms know where to obtain them.
Condom use is lowest among married couples and long-term partners with only
12% of married women reporting using condoms. 49% and 43% of young (15-24)
Page 4 Condom Use
men and women respectively said they use condoms at first sex. Never-married
young women and men were more likely than ever-married young women and
men to report using a condom the first time they had sex. Knowledge of condom
source among young men is associated with higher use. Higher educational
attainment, higher wealth quintile, and urban residence positively influence the
likelihood that young women and men will use condoms the first time they have
sexual intercourse. Condom use amongst out of school young people is very low
(37%), making this a key target group.
Condom use is highest among people with multiple partners, but also has much
room to increase: 55% of women and 68% men who had higher risk sex (with
non-marital, non-cohabiting partner) in the past 12 months reported having used
condoms the last time they had sex. 56% of men with more than two partners
reported using condoms at last sex. Never-married women are more likely to use a
condom than their married counterparts during higher risk sex, whilst 70% of both
married and unmarried men use condoms.
The probability of using a condom during higher risk sex increases with educational
attainment in men and women, and is generally higher in younger age groups
than among older adults. However deeper analysis of the SDHS data found that
consistent condom use was negatively affected by larger age differences between
partners. About half of same-aged couples reported always using condoms. This
was only true for a quarter of couples in which the male was eight years older than
his partner. (See the MCP module for more information on intergenerational and
age-disparate relationships).
Research data from the past 10 years shows an increasing number of people
reporting that they will not have sex with their partner if they believe their partner is
unfaithful and refuses to use a condom (CIET 2002 and 2007). The vast majority
of men and women agree a woman can refuse sex or insist on condom use when
partner has an STI although attitudes towards negotiating safer sex and wife-beating
are more conservative amongst rural and less educated men and women (SDHS).
Women’s perceptions of what is acceptable behaviour is more conservative than
men’s, suggesting that there is slightly more room for negotiation than women
believe. These measures however address safer sex within marriage: it’s not clear
if women feel able to ask for condoms or refuse sex within other relationships to
the same extent.
Condom Use Page 5
Condom use is generally higher the more casual the relationship and this is clearly
the case in commercial sex work. However whilst sex workers almost always use
condoms with their clients they do not with their non-paying regular partners.
Since condoms, when used properly, are an effective way of preventing the
transmission of HIV and other STIs this would suggest that HIV rates should be
lower among condom users. However, the association between condom use and
infection levels is not uniform. Infection rates among men who used condoms at
the last sexual encounter and at last higher-risk intercourse in the year before the
SDHS 2007 survey are slightly lower compared with the infection rates for men
who were also in the same situation but failed to use condoms. Among women
the opposite pattern is observed: condom use in the previous year was associated
with markedly higher levels of HIV infection. Research findings suggest that there
are a number of factors that may influence the direction of the relationship. For
example, condom use rates may be higher among individuals who are infected
because they are seeking to protect an uninfected partner. Also, reported condom
use cannot be assumed to be “correct condom use” (SDHS, p231).
However condom use at first sex is a predictor of lower HIV risk: young women
aged 15-24 who said that a condom was used during their first sexual encounter
have a lower prevalence of HIV (29%) than those who did not use a condom (35%).
The same is true for young men age 15-24: those who used a condom at first sex
have a lower prevalence of HIV (8%) than those who did not use a condom (12%).
Page 6 Condom Use
Age-Appropriate content
on Condom Use
INDIVIDUAL
LEVEL
OUTCOMES
1.
Age Group:
Under 10s
(especially 6-9
year olds)
There is little or no information available about young children’s knowledge relating to condoms, but they are likely to be exposed to condoms
through billboards and other advertising, and by seeing them on shop
counters. Empty packets and used condoms may be lying around places
they frequent. Under 10s can be armed with the basic facts about condoms in an informal way to help them prepare for more comprehensive
education later on, and to ensure they do not pick up used condoms.
Target outcome: 1
•
Increase knowledge
about condoms by
providing basic correct
information
•
•
•
•
•
Male condoms are small rubber tubes worn by males on their
penis when they have sex (choff choff). They are often white or
pink in colour.
Female condoms are bigger rubber tubes worn by females in
their vagina.
A condom is used to stop diseases, and to stop girls or women
getting pregnant.
After use, a condom looks a bit like a dried up old balloon.
If you see a condom on the ground or near the toilet, don’t pick it
up or play with it. A used condom may be infected with diseases
like HIV. Tell a trusted adult.
Swaziland has a high rate of HIV which results in peolpe becoming very sick and possibly dying, the main way the virus is
spread, this is why condom use is so important.
Condom Use Page 7
2.
Age Group:
10-14 Year Olds
(particulary 13-14
year old girls)
Amongst 12-14 year olds interviewed for the SDHS, girls
are more likely to have heard of the female condom (48%),
than boys (37%), and boys are more likely (85%) to have
heard of the male condom than girls (71%). Knowledge
is higher among urban children than rural children. Only
37% of those children who knew about AIDS and condoms
believed children their age should be taught in school to
use condoms to avoid AIDS and nearly half of children aged
12-14 say that there was too much focus on condoms in
the information on HIV/AIDS they had received in the 12
months preceding the survey.
Encouraging the use of condoms at first sex should be
an important focus for older children, especially girls, in
this age group. Although for the most part the 10-14 year
old age group are not sexually active, the groundwork
for condom use needs to be laid and the needs of those
who are already sexually mature and/or at risk should be
addressed. Among 13-15 year olds surveyed in 2003 who
had had sex, fewer than half reported using a condom at
last sex (41% of boys and 47% of girls).
At this stage limits to knowledge and access may exist,
and myths and misconceptions may take hold: it is critical
they are countered and dispelled effectively despite
the absence of an official government policy endorsing
condom education in school. Social acceptance of condom
education is relatively high: 74% of women and 72%
of men aged 18-49 thought 12-14 year olds should be
taught about condoms (SDHS). More tolerant attitudes are
somewhat associated with urban residence, never-married
status and higher education.
Page 8 Condom Use
Analysis of available data suggests that other priorities for
prevention communication among this age group should
include: increasing knowledge about and relevance of
condoms; increasing the acceptability of learning about
and using condoms; changing peer norms around the
acceptability of information and discussion about condoms;
and importantly, increasing contextual information relating
to sexuality and relationships and gender equality in which
condom information can be disseminated.
Target outcome: 1
Increase knowledge
about condoms by
providing correct
and comprehensive
information
What a condom is:
•
The male condom is a latex (rubber) sheath, closed
at one end and open at the other, which is fitted
over the erect penis before having penetrative sex
[sex where the penis goes into the vagina, anus or
mouth].
•
The female condom is a large latex sheath or pouch
with a flexible ring at each end. It is closed at one
end and opens at the other and is inserted into the
vagina before having penetrative sex. It completely
lines the vagina and helps to prevent pregnancy and
STIs including HIV.
How condoms work:
•
Condoms work as a physical barrier to protect males
and females against HIV, STIs and pregnancy.
•
Condoms are highly effective at preventing HIV, STIs
and pregnancy if used correctly and consistently.
•
Condoms have very few side-effects and can be
used by almost everyone.
•
Wearing a condom prevents direct contact between
the genitals of two people having sexual intercourse,
and prevents male sperm from entering the female’s
body.
•
Both types of condoms are usually pre-lubricated
(covered in a light oil or gel) to make them slightly
Condom Use Page 9
•
slippery. This makes them easier to put on and more
comfortable, Lubricant can help make sex more
enjoyable and prevent breakages due to friction.
You need to use a new condom every time you have
sexual intercourse. Never use the same condom
twice.
When to use condoms:
•
You should try to use a condom from the first time
you have sex as it is possible to get infected with
STIs including HIV, or for a girl to get pregnant, from
the first time of sex.
•
You can use condoms every time you have sex with
every partner to make the experience free of stress
and worry.
•
You must put the male condom on after the penis is
erect and before any contact is made between the
penis and any part of the partner’s body.
•
You can put the female condom up on to eight hours
before having sex.
Where to get condoms:
•
Both male and female condoms can be bought at
shops and pharmacies.
•
Condoms are available from health facilities free of
charge.
•
Condoms may be available in your community
through community health workers.
Where to find out more about condoms:
•
If you have questions about obtaining, using and
disposing of condoms you can ask a peer educator
or health worker or go to the Kagogo centre, a youth
club or a youth-friendly clinic.
Page 10 Condom Use
What correct and consistent condom use means:
•
Correct use means storing it, checking it, putting it
on, taking it off and disposing of it correctly, following
the instructions on the packet
•
Consistent use means using a condom every time
you have sex even with a trusted partner.
Target outcome: 2
Dispel myths and
misconceptions
There is relatively little information about which myths and
misconceptions are widespread or most strongly held in
Swaziland, and by which target groups. Many of those
cited by stakeholders are more or less generic to the
region, and should be tested before developing prevention
interventions. It may be preferable for peer educators,
teachers and other sources of advice and information to
counter specific misunderstandings and false beliefs when
they arise from questions or in discussion, rather than
bringing such issues up independently and creating doubt
and confusion where none may in fact exist.
•
Myth/misconception: Condoms can carry HIV.
Correct information: Unused condoms are not
contaminated with any bacteria or virus. Some
people incorrectly say that the condom lubricant
(this is the oil or gel on the condom which makes it
slippery and easier to use) is the HI Virus. This kind
of story may be spread around by people who do
not want to take responsibility for their health or their
sexual partners’ health.
•
Myth/misconception: If you fill a condom with water
you can see small worms.
Correct information: The lubricant (oil or gel on
the condom which makes it slippery and easier to
use) is visible under a microscope or if you fill a
condom with water. Some people think the tiny bits
of lubricant look like small worms. This story may be
Condom Use Page 11
spread by those who are finding reasons not to take
responsibility for their health or their sexual partners’
health.
•
•
•
•
•
Page 12 Condom Use
Myth/misconception: Condoms are porous and
allow HIV to pass through tiny holes.
Correct information: There are no holes in
condoms. Condoms are tested to ensure they do
not have holes and cannot leak. You should always
check condoms for tears before you use them.
Myth/misconception: You cannot use a condom
with a virgin.
Correct information: You can use a condom with a
virgin and with anyone.
Myth/misconception: There are no condoms that
can fit young boys and teenagers.
Correct information: Most normal condoms will fit
a variety of sizes of penis.
Myth/misconception: Female condoms can only fit
older women:
Correct information: Female condoms will fit all
women. They may feel a little uncomfortable at first
but with time most women get used to them.
Myth/misconception: Condoms are only protective
against pregnancy and not against HIV infection.
Correct information: Condoms are very effective
at reducing the risk of HIV infection during sexual
intercourse and protecting against other sexually
transmitted diseases. In the laboratory, latex
condoms are very effective at blocking transmission
of HIV because the pores in latex condoms are too
small to allow the virus to pass through. In practice
not everyone uses them correctly or consistently (all
•
•
Target outcome: 3
Increase relevance
of informance and
risk perception
the time).
Myth/misconception: Free and Non branded
condoms are not effective.
Correct information: All condoms are paid for by
someone! Condoms that are provided free of charge
to the user are just as effective as ones you pay
for. With all condoms you should always check the
expiry date and check that the condom is not torn.
Myth/misconception: A virgin cannot possibly have
HIV (especially believed by boys).
Correct information: Someone who has not
had sex can be HIV positive because HIV can be
transmitted from an HIV infected mother to her baby.
Also children may have been infected through sexual
abuse at a young age and/or without realising they
have had sex.
Key beliefs to instil and support:
General:
•
Sex with a condom can be enjoyable and free of
worry
•
I can use condoms every time I have sex including
the first time
•
Older partners are more likely to be infected with
HIV so I should always use a condom when I have
sex with them
•
It is good to carry condoms around, it means I am
being smart and responsible
Condom use at first sex:
•
I can get infected with HIV even at first sex
•
Female: I can get pregnant the first time I have sex
•
Male: I can impregnate a girl the first time I have sex
•
When I start having sex I should use a condom
Condom Use Page 13
•
to protect myself from HIV infection, STIs and
pregnancy
It’s acceptable that I should be prepared by getting
condoms in advance of having sex at all times
Key negative beliefs to dispel:
•
I haven’t had sex yet so condoms are not relevant to
me. Correct information: you never know when the
first time might happen – its better to be prepared
•
I believe that a girl cannot get pregnant the first time
she has sex. Correct information: once a girl starts
menstruating she can get pregnant.
•
I am too young to die or contract HIV. Correct
information: HIV can infect all ages.
•
Using condom reduces (male) sexual pleasure (‘like
eating a sweet in its wrapper’). Correct information.
It is true that you might lose some feeling but
your overall sexual enjoyment could be increased
because you don’t have to worry about the negative
consequences of sex. It may also help you prolong
the time before orgasm.
•
I do not need to use condoms when having sex with
someone of my own age because a young person
cannot be impregnated and most probably doesn’t
have HIV. Correct Information: although HIV rates are
lower amongst 10-14 year olds than older teenagers
and youth, there is always a risk of pregnancy, STIs
and HIV infection whatever your partner’s age.
Page 14 Condom Use
Target outcome: 4
Increase positive
outcome
expectations
towards condom
use (and decrease
negative ones)
Key positive outcomes of using a condom should be
promoted:
•
If I use a condom at first sex and every time afterwards
then I can have fun without worrying about negative
consequences
•
If I use a condom the first time I make love/have sex
it will be easier to use one every time afterwards
•
If I propose using a condom then my partner will
know I care about her/him
Target outcome: 5
Increase skills to
use condoms
Key skills needed by 10-14 year olds, especially 13-14
year old girls, to use condoms at first sex, and thereafter,
can be promoted through providing young people
opportunities to practice relevant communication, planning
and performance skills:
•
•
•
•
•
•
Negotiation skills to use with partner at time of first
sex: e.g. I can say: ‘I want us to use a condom’ or
‘lets wait until we have protection’ or ‘If you really
love me you will want to protect me’. “If I enjoy it
more, you will too!”
Information-seeking skills to ask for advice about
condoms
Communication skills to buy/obtain condoms from
shops, clinics, youth centres etc.
Planning/decision making skills to be prepared to
use condoms at the time of first sex: e.g. identifying
a source of affordable/accessible condoms and
obtaining them and carrying them
Planning and decision-making skills to set goals
for immediate and longer term future: e.g. I have
plans for my education and my future which will be
disrupted if I get pregnant or infected at a young age
Performance skills to actually use condoms correctly
and to dispose of them.
Condom Use Page 15
Target outcome: 6
Increase selfefficacy (confidence
in ability) to use
condoms
Page 16 Condom Use
Key areas of self-efficacy to promote:
•
It is my right to use condoms to protect myself
•
I am confident I will be able to use a condom to
protect myself when I have sex for the first time and
afterwards
•
I am confident I know where to get condoms and to
buy or obtain them
•
I am confident I will remember to carry condoms with
me in case I get into a situation where I want to have
sex
•
I am confident I can discuss and negotiate condom
use when I (eventually) have sex
•
I am confident I know how to put a male condom on
(13-14 year old girls and boys)
3.
Age Group
15-19 year olds
(especially rural,
poorer and less
educated, and
women with older
sexual partners)
In the SDHS over half of 15-19 year olds who had ever
had sexual intercourse (53% of women and 52% of men)
reported using a condom the first time. The proportion was
slightly higher for 18-19 year olds than 15-17 year olds.
Among 15-24 year olds, condom use at first sex is positively
associated with knowledge of condom source among men.
It is also positively associated with education, wealth and
urban residence for both men and women (although men
with lower primary education show lower levels of condom
use than those with no education at all).
Gender difference in condom use at last sex is marked:
only 52% of 15-19 year old women used a condom at last
sex whilst 69% of men reported doing so. This difference is
probably related to the lack of negotiating power of young
women with older male partners. Condom use at last sex
is more likely to happen among those with higher level of
education and wealth. Most sex (98%) amongst this age
group is categorised as higher risk because few young
people are married or co-habiting. The likelihood of both
women and men engaging in higher risk sex increases with
level of education and wealth quintile, and so does condom
use.
Since the likelihood of continued condom use is higher
if condoms are used first time, this must be a priority for
those not yet sexually active. Similarly there is a need to
increase intention to use condoms with all partners: since
those who are sexually active amongst this age group are
by definition almost exclusively engaging in higher risk
sex, the focus must be on using condoms correctly and
consistently with all partners. Efforts should be made to
Condom Use Page 17
reach those with relatively lower education who are mostly
no longer in school, and in rural areas.
Multiple and Concurrent partners: highlighting the risks of
multiple and concurrent partners, age disparate relationships
and sexual networks. For those not yet sexually active this
would require increasing the intention of those not yet
sexually active, or who have only one partner or no current
partner, to limit the number of partners in future.
Gender education: another focus for prevention should
be increased awareness of women’s rights, especially
in relation to sex and in marriage or any relationship.
Emphasis should be placed on changing gender-related
attitudes in relation to women’s right to obtain, carry and
initiate the use of condoms, to protect herself and to be
sexually assertive. This provides an opportunity to consider
transforming the nature of relationships, in conjunction with
risk reduction through condom use.
Building communication skills and self-efficacy for
negotiation with partner/spouse: young people need
to develop skills to talk openly about sexual issues, to
negotiate safer sex, to request that condoms be used
during sexual intercourse and to refuse sex if so desired.
Target outcome: 1
Increase knowledge
about condoms
Page 18 Condom Use
Knowledge of, and familiarity with, condoms can be built
up over time through an iterative process which starts at a
basic level amongst younger children and teenagers and
is repeated and added to over time. Below are points that
are ADDITIONAL to the information provided above for
younger age groups, and which can be disseminated to
15-19 year olds (and older age groups) once they have
been exposed to the basic elements.
What male condoms are: (basic information on male
condoms and how to use them is in the 10-14 year old
section):
•
Latex condoms can only be used with water based
lubricants and not oil based lubricants such as
Vaseline or cold cream as they break down the latex.
•
A small number of people have an allergic reaction
to latex and can use polyurethane condoms instead.
How to use a female condom (basic information on female
condom is in the 10-14 year old section):
•
At the open end of the sheath, the ring stays outside
the vulva at the entrance to the vagina. This ring acts
as a guide during penetration and it also stops the
sheath bunching up inside the vagina.
•
The female condom may feel unfamiliar at first. The
female condom feels different from a male condom
and some people find it difficult to insert. Some
women find that with time and practice using the
female condom becomes easier and easier.
•
There is silicone-based lubricant on the inside of
the female condom, but additional lubrication can
be used. The female condom does not contain
spermicide.
•
The penis should be guided into the condom in order
to ensure that the penis does not slip into the vagina
outside the condom. You can use extra lubricant so
that the condom stays in place during sex.
•
Many female condoms are made of polyurethane
and nitrile, which are less likely to cause an allergic
reaction than latex.
•
These materials can be used with oil-based as well
as water-based lubricants.
•
These materials are thin and conduct heat well, so
sensation is preserved.
•
Do not use a male condom with a female condom:
Condom Use Page 19
•
•
•
•
the friction between the two condoms may cause the
condoms to break.
If the condom slips during intercourse, or if it enters
the vagina, then you should stop immediately and
take the female condom out. Then insert a new one
and add extra lubricant to the opening of the sheath
or on the penis.
To remove the condom, twist the outer ring gently
and then pull the condom out, keeping the sperm
inside.
Wrap the condom in the package or in tissue
and throw it away. Do not put it into the toilet. It is
recommended that condoms should not be reused
No special storage requirements are needed for
female condoms because the materials they are
made of (polyurethane and nitrile) are not affected
by changes in temperature and dampness.
When to use a male condom:
•
Use a condom even if you are using another form of
contraception to prevent pregnancy, to protect you
and your partners against HIV and other STIs.
•
Use a condom even if you or your partner is
circumcised since male circumcision only provides
partial protection from HIV or STIs.
•
Use a condom every time.
•
Use a condom if you think your sexual partner has
other partners or you have other partners.
How to use male condoms consistently:
•
Use a condom every time you have sex
•
Use a condom if you have many sexual partners one
after the other (multiple partners).
•
Use a condom if you have more than one sexual
partner in the same time period (concurrent partners).
•
Note: Having sex with many partners when there is
Page 20 Condom Use
a gap of a month or more between partners is called
having multiple partners; having sex with more than
one person in the same time period or within a month
of each other is called having concurrent partners.
How to use male condoms correctly:
•
Proper storage: store condoms in a dry place out
of direct sunlight. When you carry them with you
replace them frequently so they do not get too hot or
squashed.
•
Checking the condom: make sure that the condom
wrapper is not torn before opening and make sure
the condom is not torn when you open the wrapper.
•
To put a condom on correctly, follow the instructions
on the packet.
•
Use a new condom for each act of intercourse.
•
Put on the condom as soon as erection occurs and
before any sexual contact (vaginal, anal or oral).
•
Hold the tip of the condom and unroll it onto the erect
penis, leaving space at the tip of the condom, yet
ensuring that no air is trapped in the condom’s tip.
•
Adequate lubrication is important, but use only
water-based lubricants on latex condoms. Oil-based
lubricants such as petroleum jelly (vaseline), cold
cream, hand lotion or baby oil can weaken the latex
condom and are not recommended.
•
Withdraw from the partner immediately after
ejaculation, holding the condom firmly to keep it from
slipping off.
•
Only wear one condom at a time as wearing two
increases the chances of breakage and does not
provide additional protection.
•
Do not use a male condom with a female condom:
the friction can cause breakage of the condoms.
Condom Use Page 21
Target outcome: 2
Dispel myths and
misconceptions
As noted in the 10-14 section, there is little hard information
about which of the many rumours and half-truths that tend
to circulate about condoms, are actually believed by or
are important barriers to people in Swaziland. There is
evidence to suggest that Swazi men are ‘eager to embrace
anti-condom myths as a reason to reject what they
consider a foreign and unnatural intrusion into their sex
lives’. Ideally potential obstacles to condom use should
be discussed when raised by target groups and dealt with
on a case by case basis. Responses will depend on the
nature of the group, and it is difficult to prescribe suitable
rejoinders to possible reasons that might be given for not
using condoms. The two issues below were consistently
raised in recent research conducted in Swaziland .
•
•
•
Page 22 Condom Use
Myth: Condoms were made to destroy African
manhood - the gels in condoms shorten the size and
duration of erections.
Possible response: Make putting on a condom
part of the sexual act, encourage your partner to
participate and your erection will not be affected.
Wearing a condom can help prolong your sexual
pleasure.
Myth: If you have unprotected sex wiht virgin you
will be rid of HIV. Leading to unprotected sex.
Possible response: There is no known cure for HIV/
AIDS. AIDS can be manged by living with care and
treatment. Use a condom every time you engage
in sexual intercourse, especially when you are HIV
positive.
Misconception (based on reality): Condoms
cause allergic reactions and some men develop
rashes and other problems.
Possible response: This may happen to a very few
people who are allergic to latex condoms. A different
kind of condom made of polyurethane will help avoid
this. Or ask your partner to use a female condom.
But first make sure that the rash is not due to an STI
or a reaction to a lubricant or cream that you are
applying.
Target outcome: 3
Increase risk
perception and
relevance of
information
Inaccurate risk perception is thought to be a contributing
factor to the failure of the Swazi population to use condoms
consistently. Prevention activities are needed that educate
young people to assume that risk underlies sexual activity
without letting fear dominate their feelings about sex. They
need opportunities therefore to reflect explicitly on how their
own behaviour or that of their sexual partners’ exposes
them to HIV risk, and to default to a position where using
a condom, and being protected, is a natural and enjoyable
part of sex. Since risk-taking is a part of growing up,
prevention communication needs both to convince young
people that the risk of HIV is not one worth taking and to
build and reinforce beliefs that support condom use.
Key beliefs to instil and support:
General:
•
Sex with a condom is fun because it makes me and
my partner feel free
•
I realise that healthy looking people can be HIV
positive
•
I may trust my partner now but I don’t know his or her
past sexual behaviour
•
I shouldn’t listen to people who speak out against
condom use
•
I don’t need to feel embarrassed about using a
condom: no amount of sexual pleasure is worth the
risk of getting infected with HIV
•
I trust condoms to provide protection for myself and
my partner
Condom Use Page 23
•
•
To not use a condom every time you engage in sex
is extremely risky behavior
Every human being has a right to be in control of
their sexual reproductive health, including the use of
a condom
Condom use at first sex:
•
If we use a condom, it shows we care for each other
•
I can get infected with HIV even at first sex
•
Female: I can get pregnant the first time I have sex
•
Male: I can impregnate a girl the first time I have sex
•
When I start having sex I should use a condom
to protect myself from HIV infection, STIs and
pregnancy
•
I’m taking responsibility for myself by getting
condoms in advance of having sex for the first time
•
It,s cool to carry condoms – it shows I am a real,
responsible man or woman
Condom use with an older partner:
•
I should always try to negotiate condom use with a
partner who is five or more years older than me
Condom use and circumcision:
•
Circumcision does not provide complete protection
from HIV but only reduces the chances of infection.
So even if my partner or I am circumcised we should
still use condoms during sex
Condom use with multiple and concurrent partners
•
I should use a condom if I have multiple or concurrent
partners
•
I should use a condom with all my sexual partners
since they too may have multiple and concurrent
partners which form sexual networks in which HIV
can spread very quickly
Page 24 Condom Use
Condom use by couples:
•
My partner and I can put on condoms as part of our
love-making
•
If I don’t know my status and that of my partner, no
matter how long we have been together, we should
use condoms
•
If I am in a discordant relationship (one partner is
HIV positive and the other is not) then my partner
and I should use condoms
•
If I know I am HIV positive I should always use
condoms to avoid infecting my partner
•
If both my partner and I are HIV positive we should
use condoms every time to avoid re-infection
•
If I know I am HIV negative and am uncertain of my
partner’s status I should use a condom
Condom use and STIs:
•
If I have an STI ideally I should not have sex until it
has been treated
•
If I know or think I have an STI I should use condoms
if I do have sex
•
Male: my wife or girlfriend is justified in refusing to
have sex OR insisting that we use a condom if she
knows or thinks that I have an STI
•
Female: my husband or boyfriend is justified in
refusing to have sex OR insisting that we use a
condom if he knows or thinks I have an STI
Condom Use Page 25
Target outcome: 4
Increase positive
expectations of using a
condom
Showing and persuading people that the advantages of
behaviour change outweigh the disadvantages is a vital
element in facilitating that change: people at risk need
opportunities to debate and discuss consequences of
their actions with reference to the facts underlying them.
Positive expectations need reinforcement, whilst negative
expectations should be countered and minimised, without
sidelining genuine fears and objections.
Key positive outcomes of using a condom to promote:
•
If I use a condom with my sexual partners I’ll enjoy
sex without worrying about what might happen e.g.
o Female: I don’t have to worry about getting
pregnant and not knowing who the father is
o Male: I don’t have to worry about getting them
pregnant and getting into paternity disputes
o I don’t have to worry about getting infected with
HIV or another STI
o I won’t disrupt my plans for my education and
my future
•
If I use a condom with my sexual partners then they
will know I care about my health and theirs
•
If I use a condom at first sex it will feel normal to use
one every time
•
If I tell every new partner that I always use condoms
it will be easier to continue using them all the time
•
If I use a female condom then I don’t need to interrupt
the flow of intercourse: I can insert a female condom
up to 8 hours before intercourse and it won’t interfere
with the moment
Target outcome 5:
Increase skills to
use condoms
Page 26 Condom Use
Key negative outcome expectations of using a condom,
to be countered and minimised with options and suggestions
for addressing them:
•
If I suggest using a condom, my partner will think I
•
•
•
•
•
•
do not trust or love him/her: explore what is meant
by ‘trust’ in the context of sexual relationships;
counter with the idea that protecting oneself and
one’s partner is an expression of love
WOMEN: if I insist we use a condom my partner
might leave me: discuss the pros and cons of
this risky situation and how to deal with rejection;
also introduce negotiation skills and ways of
communicating that will persuade a partner to use a
condom
WOMEN: if I insist we use a condom when my partner
doesn’t want to, he might go and find someone else
to have sex with (without a condom): discuss the
pros and cons of accepting a risky situation and
how to deal with rejection; also introduce negotiation
skills and ways of communicating that will persuade
a partner to use a condom
WOMEN: if I suggest we use a condom my sexual
partner may refuse because he is not accustomed
to women being assertive about sex. Introduce
negotiation skills and ways of communicating that
will persuade a male partner to use a condom;
explore with women and men how condoms need to
play a part in the sex lives of modern Swazi males
MEN: If I bring a condom or suggest condom use,
my sexual partner will think I planned to seduce her
and change her mind. It is natural to hope that a date
might result in sex, and it,s normal to carry condoms
to protect oneself and one’s partner
MEN: if I suggest condom use, it will disturb the flow
and my sexual partner might change her mind, so by
pausing to get a condom I might miss the opportunity
to have sex with her: putting on a condom doesn’t
have to interrupt anything – it can be a sexy part of
the foreplay
MEN: If I suggest we use a condom, my girlfriend will
Condom Use Page 27
•
•
Target outcome: 6
Increase selfefficacy (confidence
in ability) to use
condoms
Page 28 Condom Use
know I have another sexual partner and have been
unfaithful. If she is right then perhaps you should try
talking about the fact you have other partners: at
least convince her that you care enough about her
to want to protect her
WOMEN: If I suggest we use a condom, my husband
or boyfriend will know I have another sexual partner
and have been unfaithful. If he is right then perhaps
you should try talking about the fact you have other
partners or have had them in the past: convince him
that you care enough about him to want to protect
him whether or not you have been unfaithful
WOMEN: if I insist on using a condom with my
husband or boyfriend he will accuse me of being
unfaithful and might beat me up. It is hard to advise a
course of action when women fear a violent reaction
from their partner. It may be possible to bring
condoms into sex by focusing on behaviour prior to
the current relationship rather than infidelity within it
Key skills needed by 15-19 year olds to use condoms:
•
Verbal and non-verbal skills to show assertiveness
in relationships (particularly for girls) and to discuss
sex with partners
•
Planning/goal-setting skills for immediate and longer
term future
•
Negotiation skills to initiate use of condoms with all
partners every time
•
Planning/decision making skills to buy and have
ready condoms every time
•
Performance skills to actually use condoms correctly;
and dispose of them
Through observation, role modelling and practice, young
people can be helped to develop the confidence to assert
their rights and needs in relation to condoms:
Key areas of self-efficacy to promote:
•
I feel able to initiate a discussion about condom use
whenever I have sex
•
I feel able to protect myself when the need arises
•
I am justified in insisting on condom use if I know my
partner has other sexual partners
•
I can stand up to my peers if they talk against
condoms. I don’t have to accept what they say
•
I am confident I will be able to put on and dispose of
a male condom correctly when I need to use one
•
Females: I have the power and the right to make
decisions in a relationship
•
Females: Insisting on condom use is my right
•
Females: I am confident I can insert and dispose of
a female condom when I need to
Target outcome: 7
Increase perceived
positive social
norms relating to
condom use
Young people need to feel that condom use is a normal
and acceptable part of life, and not feel ashamed, guilty or
embarrassed about using them during sex. Creating and
reinforcing peer group norms that support condom use
should be a key goal of prevention interventions, as well
as changing wider societal norms regarding condom use.
•
•
•
•
Sex is an important and normal part of life: therefore
it is acceptable and normal to protect myself and to
understand why, when and how to use condoms
It is acceptable and normal to buy or obtain and carry
condoms, whether I am female or male, married or
unmarried, in a relationship or not
Just because older people were not brought up with
condoms doesn’t mean they have the right to tell me
that I shouldn’t use them
It is not acceptable for (older) men to put (younger)
women at risk of HIV by refusing to use condoms
during sex because they give them money, food or
gifts in exchange
Condom Use Page 29
•
Page 30 Condom Use
Condoms are not just for casual relationships:
they can and should be used in long-term sexual
partnerships
4.
Age Group:
20-24 Year Olds
(especially those
not in education
and who have
migrated away from
home)
By the age of 20, over 70% of women are sexually
active. HIV prevalence among women jumps from 10%
among 15-19 to 38% among 20-24 (close to the antenatal surveillance estimate) with a significant increase
even between 18-19 year olds (16%) and 20-22 year
olds (36%). Among males aged 20-24, HIV prevalence is
12.4%; less than a third of the female rate, and 57% of
men are sexually active by the age of 20. Only 38% of 2024 year old women report having used condoms at first
sex compared to 48% of men; 56% of unmarried women
(compared to 71% of men) used condoms during last sex
with a higher risk partner. Given the higher rates among
older men and information available about the nature of
many sexual relationships in Swaziland, we can conclude
that intergenerational sex, fuelled by transactional
exchanges, is a key driver of HIV among women in this
age bracket.
Knowledge of condoms as a protective measure is high –
around 90% for this group; but knowledge that practices
such as anal and oral sex are risky for HIV is low – around
60% overall.
Women in this age group are an important target for
prevention centred on condom use because they are
at a transitional period in their lives which make them
particularly vulnerable to infection. Reasons why women
are likely to be taking more risks than men may relate to
differentials in their education and employment status:
at age 20 nearly 45% of men are in education, but only
around 15% of women. Being in education appears to be
a protective factor. The gap closes each successive year
to the age of 24 when around 5% of both sexes are still in
Condom Use Page 31
education. Since overall only 5% of 20-24 year olds report
having tertiary level education, many 20-24 year olds
(especially men) must still be in secondary school. Men also
significantly outnumber women in terms of employment:
45% of men in this age group have a job, whilst only 34%
of women are employed.
Rural-urban migration may also expose young people to
risk as HIV rates are higher amongst urban dwellers than
rural ones. Urban women aged 15-24 have a higher risk of
HIV infection than their rural counterparts: 27% compared
to 21%. Among men aged 15-24, 7% of urban dwellers are
HIV positive compared with 6% of rural dwellers. Although
the 20-24 year old age group represents under 10% of the
total population, over 12% of them live in urban areas – this
is a notable shift since all younger age groups are overrepresented in rural areas. It is also at this point that the
demographic pyramid starts narrowing quite rapidly.
Reasons for the migration are clear: many secondary and
all tertiary-level education institutions are located in towns,
and people move to seek employment or opportunity that
is lacking in rural areas. These young people are adults
and may no longer be tied to their family (whatever form
that takes): though they may stay with relatives in town it
is likely that familial and community control over behaviour
is weakened. Marriage rates are low at this age: 20%
of women and 4% of men aged 20-24 at the time of the
SDHS survey were married, and a further 13% women and
3.5% men were living with someone. Only 13% of women
and 3% of men aged 20-24 had first married before the
age of 20 but 73% and 64% respectively had had sexual
intercourse by the age of 20.
The implications of the above for condom prevention
activities among 20-24 year olds are multiple: clearly sexual
Page 32 Condom Use
activity is taking place under a variety of circumstances,
most of it ‘higher risk’ and without full cognisance of risk
or ability to mitigate it. Secondary school sex education
needs to take into account the fact that the content must
be appropriate for and appeal to a much wider age range
than the official secondary school ages of 13-17 years,
especially to young men in their late teens and early 20s.
Tertiary institutions are of course a target too but increased
efforts are needed to reach those in employment, both
formal and informal, and those who are out of school but
not employed and who live in towns.
Women who are engaging in transactional and
intergenerational sex to survive, or to pay for educational
needs or to supplement their earnings are a key subgroup for whom condoms represent the best means of
protection. The hardest group to reach - women who are
neither in education or employment - are possibly the
most vulnerable. They will need skills and self-efficacy to
negotiate condom use, and social support from peers and
older adults to challenge the way in which older men are
currently able to dictate unsafe sexual practices due to
financial and gender inequalities. For young men increased
accurate risk assessment will be important and should be
based on a greater understanding of how same-age (or
older partner) relationships pose HIV risk due to the agedisparate partnerships that their girlfriends may engage in.
This is a time when men can be introduced to new gender
norms that will support them to use condoms in current
and future relationships especially if they themselves have
younger partners in due course. In the longer term, structural
interventions that permit women access to education,
training and employment and result in their economic and
financial equality with men would also enable them to insist
on, or more successfully negotiate condom use.
Condom Use Page 33
Target outcome: 1
Increase knowledge
about condoms and
when to use them
Below are points of information that will enhance the basis
for risk assessment and protection using condoms:
Gender issues:
•
In Swaziland, women aged 20-24 are three times
more likely to be infected with HIV than men of the
same age. This is due to the fact they start having
sex earlier, and often with older men who are already
infected.
•
Young women are not always able to negotiate safer
sex because they lack social and financial equality
with their older partners.
•
The average age of marriage in Swaziland is 27 and
the average age of sexual debut is 18: most men
and women have pre-marital sex.
•
Marriage is no protection against HIV unless the
husband and wife are mutually faithful and know
each other’s status.
Sexual practices:
•
Oral sex involves giving or receiving oral stimulation
(i.e. sucking or licking) to the genitalia. Both giving
and receiving oral sex can lead to the transmission
of STIs such as herpes, genital warts, chlamydia
and gonorrhoea, as well as Hepatitis. This is more
likely if there are lesions, cuts or ulcers in the mouth
or the genitals of either partner.
•
There is a small risk of HIV transmission if sexual fluid
(semen or vaginal fluid) or blood (from menstruation
or a wound somewhere in the genital or anal region)
from the HIV positive partner gets into a cut, sore,
ulcer or area of inflammation somewhere in the
mouth or throat of the uninfected partner. The linings
of the mouth and throat are very resistant to viral
infections such as HIV, so infection is unlikely if they
are healthy.
Page 34 Condom Use
•
•
•
•
Target outcome: 2
Increase risk
perception and
relevance of
information
The risk of being infected with an STI or HIV from
oral sex can be reduced by using condoms. Use
flavoured condoms if the taste of latex or spermicide
is off-putting.
Anal sex is sexual intercourse where the penis (or
finger or mouth) stimulates or penetrates the anus
and is performed by a man on a woman, or another
man. Anal sex can transmit STIs including HIV.
Anal sex carries a higher risk of HIV than vaginal
sex as the lining of the anus is more delicate than
the lining of the vagina, so is more likely to be torn
or grazed during sex, permitting semen to enter the
bloodstream. There is also risk for the male who
inserts his penis. Any contact with blood during sex
increases the risk of infection.
Always use a condom if you have anal sex, but only
with water-based lubricants.
Key beliefs to instil and support:
•
I am part of a sexual network if I or my partner has
other partners; we should use condoms to protect
ourselves.
•
I am justified in insisting on a condom if I think my
partner has other partners.
•
If my partner is older than me and/or financially
better off, and gives me things in return for sex, I am
at risk of HIV.
•
If my partner and I want to have anal sex we should
use a condom.
•
If my partner and I want to have oral sex we should
discuss whether to use a condom.
Condom Use Page 35
Target outcome: 3
Increase positive
expectations of
using a condom
Ideally a lot of the groundwork can be laid at an earlier age
in preparation for using condoms at time of first sex. Young
men, many of whom are having sex for the first time, need
to consider the pros and cons of using condoms with same
age girlfriends, whilst young women need to think through
the consequences of being reliant on an older partner who
provides either the means of survival or desirable material
items, and possibly social status and self-esteem.
Key positive outcomes of using a condom to promote:
•
MEN: if I use a condom I won’t have to worry about
whether my girlfriend has (had) other partners
•
WOMEN: if I ask that we use condoms I will feel more
like an equal partner in my relationships
•
WOMEN: if I insist we use condoms I will be protecting
my same-age boyfriend
Key negative outcome expectations of using a condom,
to be countered and minimised with options and suggestions
for addressing them:
•
WOMEN: if I insist we use a condom my older, richer
partner might stop giving me money, food, or gifts:
discuss the pros and cons of this risky situation
and how to use negotiation skills and ways of
communicating that will persuade a partner to use a
condom, or find alternate ways of meeting needs
Target outcome: 4
Increase skills to
use condoms
Page 36 Condom Use
Key skills needed by 20-24 year olds to use condoms:
•
Negotiation and communication skills (particularly for
women) to discuss HIV risk with partners
•
Persuasion and strategising skills to introduce
condoms as an enjoyable part of sex with same age
and older partners
•
Refusal skills to say no when older, richer partners
demand unprotected sex
Target outcome: 5
Increase selfefficacy (confidence
in ability) to use
condoms
Key areas of self-efficacy to promote:
•
I am confident I can initiate a discussion about HIV
risk with my partners
•
I am confident I can persuade my partners to use a
condom, or refuse to have sex
Target outcome: 6
Increase perceived
positive social
norms relating to
condom use
Key social norms to promote:
•
Women have the right to talk about sex and condom
use in a relationship
•
Men should not try to exert power over women and
force them to take risks
•
It is not acceptable for my generation of men to put
younger women at risk of HIV by refusing to use
condoms during sex because they give them money,
food or gifts in exchange
•
Condoms are not just for casual relationships:
they can and should be used in long-term sexual
partnerships including among married couples
Condom Use Page 37
Age Group:
25 year olds and
older
(with an emphasis
on couples and
mobile populations)
5.
HIV rates peak at 49% among 25-29 year old women and at
45% among 35-39 year old men. Knowledge of condoms is
consistently high until the over 50s are considered, among
whom it is only 70% and this is reflected in the extremely
low levels of comprehensive knowledge of older people –
21% and 25% among women and men respectively.
Condom use at last higher risk sex rises to 63% among
25-29 year old women but falls away to 42% among 40-49
year olds. For men it hovers around 70% among groups
aged 15-29 years then falls away to 53% among 40-49
year olds. There is a significant drop too in the percentage
of men with two or more partners in the previous 12 months
who used condoms at last sex – from 61% of 25-29 year
olds to 26% of 40-49 year olds. Older people have higher
risk sex (12% of women and 10% of men) but do not use
condoms in significant numbers. As noted elsewhere due
to higher male death rates the number of women starts to
significantly exceed that of men in their cohort from age
20-24: coupled with the social practice of intergenerational
relationships, older women are very likely to be exposed
to sexual networks even if they are faithful to one man.
Divorced, separated and widowed women will likely form
a notable proportion of this group. HIV risk also occurs
when married or co-habiting couples experience temporary
separations as one partner travels or resides elsewhere for
work purposes: both may have other partners on a short or
longer term basis.
As described elsewhere older men appear to use their
greater social and financial status to insist on unprotected
Page 38 Condom Use
sex with younger women, reinforced by the belief that these
sexual partners are uninfected. Whilst some interventions
will address women to support them to avoid risk, prevention
strategies will need to target men, to change attitudes to
ward condom use and to intergenerational relationships,
and to promote gender equality especially in the bedroom.
A substantial proportion of older adults know their HIV
status: over 45% of 25-39 year old women, and around
30% of men this age. Decisions about using condoms
with the knowledge of one’s status is an important issue to
address in prevention education.
Target outcome: 1
Increase knowledge
and dispel myths
Whilst most knowledge areas should ideally be covered at
earlier ages, there is clearly a need for education directed
at those who have long left school or never attended it,
focusing on the efficacy and normality of condom use.
Target outcome: 2
Increase risk
perception and
relevance of
information
Core beliefs to be promoted should focus on condom use in
the context of MCPs, sexual networks and mobility: these
issues have rarely been raised in the past, and yet are key
to the HIV risk among the 25+ age groups.
•
•
•
•
If I have concurrent partners I may be part of a sexual
network, and at risk of HIV: condoms are the safest
form of protection
If my partner has other partners I may be part of a
sexual network and at risk of HIV: condoms are the
safest form of protection
If I travel for work I should always carry condoms, and
use them if I have sex while I am away from home
If my husband or wife or co-habiting partner travels
away for work I should always use a condom if I have
sex with other partners
Condom Use Page 39
•
•
•
Target outcome: 3
Perceived social
norms
Page 40 Condom Use
•
•
If my spouse or I are HIV negative we should always
use condoms to prevent infection
If my spouse and I are both HIV positive we should
use condoms to prevent infection (or re-infection.
If I don’t know my HIV status, and/or that of my
partner, I should use condoms
Condoms are not just for young people: they can and
should be used throughout one’s life in and outside
marriage
Women do not have to be submissive: they can be in
control of their lives including their sex life
SOCIAL AND ENVIRONMENTAL LEVEL OUTCOMES
For all primary target groups there are a number of secondary audiences who
need to be reached. These secondary groups either interact with the primary target
group at an interpersonal or community level, or they are in a position to influence
and change the environment in which condom use takes place. The table below
lists suggested secondary audiences for under 10s and 10-14 year olds; for 15-24
year olds and for the 25+ age group.
Social outcomes are changes in social interactions and cultural norms and practices
which will support the individual changes detailed in the earlier parts of the module.
The actions listed in the social outcomes column will be taken by secondary
target groups when they interact directly with the primary target group in terms of
communication and support. For example, teachers will need to provide accurate
and unbiased information on condoms and provide opportunities for students to
seek clarification. But before they can do this their own capacity for communication
around condoms needs to be created or enhanced: therefore the actions listed in
the environmental outcomes column show how the secondary target groups will be
sensitised, trained, informed and enabled in order to achieve outcomes at a social
level.
Some institutional secondary target groups, such as NERCHA or business
associations or bar owners, do not interact directly with the primary target audience
to support condom use, so the words not applicable will appear in the social
outcomes column next to these groups. Instead, they are responsible for creating
an enabling environment for condom use to enable social support and normative
change, and to sustain individual level changes. Their actions will include policymaking and implementation (at various levels – national, local, organisational)
as well as resource allocation and capacity building of other secondary and
intermediate target groups: these actions appear in the environmental outcomes
column.
Condom Use Page 41
Page 42 Condom Use
Secondary
target
group
Parents,
caregivers,
guardians,
trusted
relatives,
older siblings
Primary
target
group
Under
10s and
10-14
year olds
TARGET GROUPS
NOTE: 40% of 10-14 yr olds do not
• Increased skills in parent-child
live with a parent
communication
• Inform children about condoms and • Increased awareness by parents/
encourage them to be prepared to
care-givers of lifeskills goals
use condoms at first sex
and content, creating buy-in and
• Provide non-judgemental
acceptance for condom education
information about condoms to
• Increased understanding that
children
condom education does not
• Pilot scheme of parent-to-parent
encourage sexual intercourse
discussions and mentoring (in
among children
school or community) to facilitate
parental support for condom
ENVIRONMENTAL OUTCOMES
(changes to laws and policies,
goods and services, and broader
structural conditions, that will
enable and sustain social and
individual behaviour change)
Increase social support for
Increase environmental
condom use and reinforce social support for condom use
and group norms that support
people to use condoms
SOCIAL OUTCOMES
(changes in social interactions and
norms that will support and enable
individual behaviour change)
Condom Use Page 43
• Develop national condom policy
and communication strategy
working with MOET to create buyin
Not applicable
NERCHA,
MOHSW,
HIV/AIDS
stakeholders
• Increased awareness that condom
education is not the same as
condom promotion.
• Increased tools and skills for
introduction of condoms within
lifeskills curriculum and sexuality
education
• Increased skills and incentives to
organise and support school AntiAIDS clubs or similar
• Review MOET policy concerning
condom education in schools,
differentiating between lifesaving condom education and
active promotion of condoms if
necessary
• Support integration and expansion
of condom-related information
issues within lifeskills curriculum
through policy formulation, training
and resource allocation
• Provide accurate and unbiased
information on condoms and
provide opportunities to for children
to seek clarification
• Inform parents of lifeskills
educational/ developmental goals
and content: create buy-in
• Participate in pilot scheme to give
parents guidance for talking to
children
MOET, School Not applicable
boards,
administrators
Teachers and
carers
at day
centrers, and
NCPs
Page 44 Condom Use
• Provide accurate information on
condoms
• Support young people in their care
to protect themselves
• Support gender equality to buy
and carry their own condoms and
initiate condom use
• Support idea that ‘better to be safe
than sorry’: its acceptable to plan
for sex
• Provide gender specific peer
education on risks of MCP and
sexual networks and role of
condom in reducing risk
• Promote norms of acceptability
of condoms and women’s role in
controlling when, with whom and
how they have sex
Secondary
target
group
Older adults,
Parents,
caregivers,
guardians
Peer educators
15-24 year
olds
• Increased tools and skills for
condom-related education
• Increased parental and
community awareness of
lifeskills curricula content
ENVIRONMENTAL
OUTCOMES
(changes to laws and policies,
goods and services, and
broader structural conditions,
that will enable and sustain
social and individual behaviour
change)
Increase social support for
Increase environment
condom use and reinforce social support for condom use
and group norms that support
people to use condoms
SOCIAL OUTCOMES
(changes in social interactions and
norms that will support and enable
individual behaviour change)
Primary
target
group
TARGET GROUPS
Condom Use Page 45
• Be role models and communicate
about condoms to young people
in their charge at school and
university
• Provide individual and couple
counseling and pre-marital
guidance
• Be proactive and non-judgemental
in distributing male and female
condoms to clients; deliver
demonstrations and provide
opportunities for condom use
practice
• Media/Celebrity role models
endorse new norms around
condom use being acceptable and
compatible with Swazi culture
• Media/Celebrity role models
publicly speak out about risks
associated with MCPs, intergenerational sex and sexual
networks, and endorse condom
use
Teachers/
lecturers
Counselors/
mentors
Health workers
Media houses
and
personalities
• Media houses develop soap
operas and other programmes
that refer or allude to correct
condom use at first sex and
during higher risk sex – ‘better
be safe than sorry’; counter
myth that free condoms are
ineffective
• Media campaigns and
programmes on women’s rights
and sexual and reproductive
health rights
• Increased skills for integrating
condom education in HIV
testing and male circumcision
centres
• Increased skills and tools for
teaching about condoms within
lifeskills curricula
• Link condom promotion to
circumcision promotion
• Increased skills and incentives
to facilitate extra-curricula youth
programmes
Page 46 Condom Use
MOET, School
boards,
administrators
Not applicable
• Publicly advocate for acceptability
of condoms as an HIV prevention
measure
• Publicly speak out about risks
associated with MCPs, sexual
networks and intergenerational
relationships: promote norm that
condom use for HIV protection is
compatible with Swazi culture
• Promote new concepts of
manhood in traditional trainings,
settings and rituals that support
the notion of taking responsibility
for the health of oneself and one’s
partners
• Support integration and
expansion of condomeducation within lifeskills
curriculum through policy
formulation, training and
resource allocation
• Enforce teachers service
act: create zero tolerance
for intergenerational and
transactional sex by adults in
positions of responsibility with
young people in their charge
• Increased awareness of
and communication skills to
promote acceptability and
necessity of condoms in HIV
prevention
• Increased understanding
of condom’s place in HIV
prevention
• Lobby authorities for increased
access to condoms in rural
areas
Condom Use Page 47
Employers
and business
associations,
Ministry of
Labour, IOM,
ILO, Unions
Employers
and business
associations,
Ministry of
Labour, IOM,
ILO, Unions
Not applicable
• Increase access to male
and female condoms, free,
subsidised or commercially
priced at workplaces, sports
venues, truckstops, hotels,
social venues including rural
areas
• Pay for peer educator led
discussions and condom
demonstrations at workplaces
• Develop programmes of
training, apprenticeships, social
businesses (e.g. microfinance)
esp. for women
Page 48 Condom Use
MOHSW, HIV/
AIDS service
organisations
• Lobby for policy to
establish free access
to condoms for young
people
• Finalise, disseminate and
promote national condom
strategy
• Identify ways to provide
support in cash transfers
or education, training,
income-generating
schemes and employment
to help women avoid
exploitative sex
• Lobby government to
show leadership on
gender equality and
enact policies to support
women (in particular) to
avoid taking SRH risks for
economic reasons
• Provide training to peer
educators, religious,
traditional and community
leaders as needed
• Increase condom
distribution esp. to rural
areas and non-traditional
outlets.
Condom Use Page 49
25 years
old and
over
Primary
target
group
SOCIAL OUTCOMES
(changes in social interactions and
norms that will support and enable
individual behaviour change)
Secondary Increase social support for
target
condom use and reinforce social
group
and group norms that support
people to use condoms
Health
• Provide condom use counseling
workers
and information at multiple
opportunities
Employers Not applicable
of
migrating
and mobile
workers
(e.g.
factory
owners,
sugar cane
farms,
trucking
companies
etc.)
TARGET GROUPS
• Increased skills and knowledge
to integrate condom use into
health education
• Develop workplace HIV/AIDS
policy that recognises explicitly
risks of family separation
and includes condom
demonstrations
• Make provision for partners
and families to live with migrant
employee
• Offer terms and conditions of
employment that recognize
need for family visits
ENVIRONMENTAL OUTCOMES
(changes to laws and policies,
goods and services, and broader
structural conditions, that will
enable and sustain social and
individual behaviour change)
Increase environmental support
for condom use
Page 50 Condom Use
Media
houses
•
Traditional
leaders
• Older adult role models
endorse condom use; reject
intergenerational sex and
gender norms that perpetuate
unsafe sexual practices
•
•
•
• Media portrays condom use as
part of responsible sex, (popular
celebrities and soaps rarely if
ever depict situations where
condoms are used during sex )
• Media campaign to normalise
condom use among all Swazis,
including older people
• Facilitate/permit access for bar
and club-based HIV prevention
programmes including condom
demonstrations
Provide pre-marital and
• Increased skills and awareness
marriage guidance with condom
among female community/
skills building – use platforms
opinion leaders for condom
such as ‘kitchen teas’ or similar
promotion
Publicly endorse condom use as • Increased acceptance and
an acceptable form of protection
awareness among religious
against HIV
leaders of condoms for HIV
prevention
Promote faithfulness and
• Increased skills and awareness
condom use for HIV protection
among traditional leaders for
as new norms in cultural
condom promotion in traditional
activities
settings
Promote new concepts of
manhood in traditional settings
and rituals e.g. Lusekwane
Not applicable
Religious
leaders
Entertainment
business
owners
Female
traditional
leaders
Condom Use Page 51
Not applicable
Ministry of
Labour, ILO,
IOM, Unions
http://www.avert.org/condom.htm
http://www.avert.org/female-condom.htm
Resources:
Not applicable
NERCHA,
MOHSW,
HIV/AIDS
service
organisations
• Work with employers to
facilitate employment terms and
conditions that mitigate against
MCP
• Job creation, livelihood skills
development and incomegeneration programmes for
adults, especially women
• Train and sensitise different
groups as required (leaders,
teachers, peer educators,
health workers)
• Develop condom
communication strategy