Single young men and women in urban Cameroon are more likely to have ever used a condom if they perceive that they are personally at risk of HIV infection or that their parents support condom use. Of approximately 1,300 sexually experienced young persons surveyed in 2000,1 more than three-quarters had used a condom at least once; however, fewer than half always used condoms with casual partners, and fewer than one-quarter always used them with their regular partner. Young men and women were more likely to report current use of condoms if they were confident that they could use one correctly and that they could persuade their partner to use one.
Data for the analysis came from the survey responses of the 1,284 sexually experienced participants from a randomly selected sample of 15-24-year-olds residing in Cameroon's two largest cities, Yaoundé and Douala. To identify factors affecting condom use among young people, trained, same-sex peer interviewers had asked respondents whether they had ever used condoms and whether they had used condoms during their most recent sexual intercourse with a regular partner and during their most recent intercourse with a casual partner. Respondents had also been asked how frequently they used condoms with regular partners and casual partners. Those who reported always using condoms were considered consistent users. The survey also assessed respondents' perceptions about characteristics of condoms and personal access to condoms, the potential impact of pregnancy and HIV on their lives, support for condom use in their social environment, perceived personal susceptibility to pregnancy and sexually transmitted infections, and self-efficacy--their belief that they could use condoms correctly and could persuade their partner to use condoms.
Of the 557 female and 727 male respondents with sexual experience, slightly more than four in 10 were aged 15-19 years; approximately nine in 10 had attended or were currently attending secondary school, and more than half were currently students.
Half of male respondents (50%) but fewer than one-third of female participants (27%) reported having had multiple partners in the previous year. Nearly eight in 10 respondents (78% of males and 77% of females, respectively) reported having used a condom at least once; that proportion was higher among 20-24-year-olds (82% and 82%) than among 15-19-year-olds (71% and 72%). Fewer than half of young women and men (31% and 45%) used them consistently with casual partners, and even smaller proportions (14% and 20%) used them consistently with regular partners. In their most recent sex with a casual partner, 47% of young women and 60% of young men had used a condom. Thirty-four percent and 45%, respectively, reported condom use in their most recent sex with a regular partner; among female participants, this proportion differed by age (40% of teenage respondents vs. 29% of respondents in their early twenties).
In logistic regression analyses that controlled for number of partners, age, level of education, current school enrollment and socioeconomic status, variables related to perceived parental support and perceived personal susceptibility were associated with ever-use among male and female respondents. For example, the odds of use were higher among male and female participants who believed that having sex without a condom put them at moderate or high risk of HIV than among those who perceived minimal or no risk (odds ratios, 1.7 and 2.0, respectively). Respondents who perceived that their parents supported use were more likely to have ever used a condom than respondents who perceived no such support (1.6 and 2.5). The odds of ever-use were also elevated among female respondents who perceived AIDS as nonfatal (2.6).
Personal characteristics were also associated with ever-use. For example, the odds of ever-use increased with age for male and female participants (1.2). In addition, young men who had had multiple recent sexual partners were more likely to have used condoms (2.5), and female respondents who lived in Douala were less likely to have done so than those who lived in Yaoundé (0.6).
Condom use at most recent sex with a regular partner was associated with perceived condom attributes and self-efficacy among young men and with self-efficacy among young women. Male and female respondents were significantly more likely to report recent use of a condom if they believed that they could persuade their regular partner to use one (odds ratios, 8.9 and 20.7, respectively) and if they were confident in their ability to use condoms correctly (1.9 and 2.0). However, the odds that young men had used a condom at their most recent sex with a regular partner were reduced if they believed that condom use makes sex less pleasurable (0.6). For female respondents, age was negatively associated with recent use with a regular partner (0.9).
The analysis examining condom use with a casual partner at most recent sex was conducted for male respondents only, because few young women reported having a recent casual partner. Young men who perceived their personal risk of HIV infection as moderate or high had elevated odds of recent use with a casual partner (2.6), as did those who knew of a nearby source of condoms (2.7). The odds were also higher among young men who believed they could convince casual partners to use condoms (7.7) and those who felt confident about their ability to use condoms correctly (3.1).
The researchers note that their study is limited by its reliance on self-reported data and that cross-sectional data cannot necessarily establish causal relationships. Nonetheless, they believe their results show a strong association of condom use with perceived personal risk, self-efficacy, and perceived parental support for use. They recommend that future condom-promotion programs in urban Cameroon and similar settings should promote parental support, convince young persons that their sexual history can put them at risk of HIV infection, convey the message that HIV risk from sex with regular partners is not low, and encourage the perception that they can use condoms correctly and can convince their partners to use them.--C. Coren
1. Meekers D and Klein M, Determinants of condom use among young people in urban Cameroon, Studies in Family Planning, 2002, 33(4):335-346.