Open Access“I’d Rather Use a Refuse Bag:” A Qualitative Exploration of a South African Community’s Perceptions of Government-Provided Condoms and Participant-Preferred Solutions
Author(s) -
Cho Hee Shrader,
Kenisha Peters Jefferson,
Mariano Kanamori,
Roger W. Rochat,
Aaron J Siegler
Publication year - 2020
Publication title -
archives of sexual behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.288
H-Index - 111
eISSN - 1573-2800
pISSN - 0004-0002
DOI - 10.1007/s10508-020-01701-2
Subject(s) - condom , social marketing , focus group , masculinity , government (linguistics) , public health , qualitative research , psychological intervention , social psychology , psychology , medicine , environmental health , family medicine , gender studies , political science , sociology , public relations , marketing , human immunodeficiency virus (hiv) , business , nursing , social science , linguistics , philosophy , syphilis
Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.