Abstract
Background: Condom use is an effective prevention method for sexually transmitted diseases (STIs), including the human immunodeficiency virus (HIV). However, there is a low level of condom use among men in South Africa. Hence, it is necessary to understand the factors that correlate with condom use among circumcised men for targeted interventions.
Aim: To determine the factors associated with condom use among circumcised men in South Africa.
Methods: Secondary data from the 2017 South African National HIV Prevalence, Incidence and Behavior Survey (SABSSM V) collected by the Human Sciences Research Council (HSRC) were analysed using an analytical cross-sectional design. The retrospective analysis included 757 circumcised men who were 15 years of age and above at the when the survey was conducted. The participants' characteristics were descriptively summarised using frequencies and percentages. Bivariate and multivariate logistic regression were conducted based on crude odds ratios (cOR), and adjusted odds ratios (aOR), respectively, to evaluate the association between condom use and other variables such as sexual history, demographic, socio-economic, socio-cultural, and lifestyle factors in circumcised men in South Africa. The significance level was set at p<0.05 using a 95% confidence interval (CI).
Results: The mean age of circumcised men was 29.5 years, with 39.6% (300) between age 15-24 years, 35.8% (271) between 25-30 years, 113 (14.9%) between 35-44years and 9.6% (73) were above age 45 years. Most of the men were from the African race 83.8% (591), 8.1% (57) were Coloured, 4.5% (32) were White and 3.5% (25) were Indian. The findings of the study show that the majority i.e., 76.7% (551) of the study participants have used condoms with any of their partners within the last three months. Circumcised men residing in rural areas (farms) [aOR=0.42 95%CI (0.20-0.91), p<0.027] and Limpopo province [aOR=0.36 95%CI (0.16-0.80), p<0.012] were less likely to use condoms with any of their partners in the last three months in comparison to those from urban areas and Western Cape province, respectively. Men who were sick/disabled and unable to work were more likely to use condoms with any of their partners in the last 3 months [aOR=2.30 95%CI (1.17-4.51), p<0.015]. Unemployed men were less likely to use condoms with any of their partners in the last 3 months when compared to the employed [aOR=0.07 95%CI (0.01-0.80), p<0.032]. Those aged 30 - 35 years were more likely to use condoms with any of their partners in the last 3 months when compared to men that were < 18 years of age [aOR=1.32 95CI (1.15-1.01), p< 0.001]. Being urged to use condoms was associated [aOR=0.32 95%CI (0.10-0.99), p< 0.049] and using condoms sometimes [aOR=0.19 95%CI (0.08-0.45), p< 0.001] were associated with the use a condom in the past 3 months.
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Conclusion: Socio-demographic, cultural, economic, and behavioural factors were significantly associated with condom use among circumcised men aged 18 years and above in South Africa. Targeted and context-specific strategies to promote condom use among men are crucial to prevent STI transmission.