Page 132 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 8 of 9 Original Research

perceived benefits were significantly high. Similarly, other sex and the importance of condom use in all types of
studies have found that people engage in a mix of MSP, nCU relationships, especially where high-risk sexual behaviour
and transactional sex to access a fashionable lifestyle. 19,24 This takes place such as MSP. Secondly, these results show that
may be also explained why we found that students were initiatives need to focus more closely on changing cognitive
more likely to engage in risky sexual behaviours as they are and psychosocial thinking in terms of personal beliefs and
vulnerable to peer pressure and living up to a standard. The norms including the constructs of perceived benefits and
findings of this research showed that the participants did not perceived susceptibility. This could be done through
use condoms because of their perception of benefits acquired. enhancing awareness of HIV risk in the general population
They perceived that not wearing condoms will make them and other cognitive behaviour change interventions.
get more money as compared to wearing condoms and the Therefore, community mobilisation, advocacy, creating
risk for HIV infection. activities to improve self-esteem and aim to increase risk
perception are of paramount importance.
The findings of nCU after adjusting for confounders of
transactional sex, alcohol use before sex and MSPs revealed Multi-sectorial efforts focusing on the social and structural
that personal beliefs had an impact on condom use. drivers of risky sexual behaviours and HIV need to be
Participants believed that it was unpleasurable to use prioritised. This includes psychosocial, health, educational
condoms. This is consistent with other studies that have and economic interventions. Lastly, the findings of this
revealed that attitudes about condoms are predictive of research will contribute to the knowledge about personal
condom use. While marital status strongly correlated with intrinsic factors and the psychosocial factors that predispose
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nCU and remained stronger after adjusting for confounders, people to engage in risky sexual behaviours and help close a
being married was significantly associated with nCU; this is literature gap in understanding the dynamics of the epidemic.
consistent with most studies. This finding is concerning and Cognitive factors must be prioritised and explored further in
people in all types of relationships should be encouraged to terms of the roles they play in HIV incidence.
use condoms, especially in a country where MSP is common
practice regardless of marital status. Acknowledgements

The authors acknowledge access to the analysed data from
Living in a rural area or farming settlement was found to be the Third NCS. The NCS is a collaborative survey undertaken
a risk factor for not using condoms at last sex. This could be by Johns Hopkins Health and Education in SA, loveLife
because of stigma and patriarchal norms which play a larger and Soul City. The survey was managed by Health and
30
role in determining behaviour. This could also be because of Development Africa (HAD). The Johns Hopkins Bloomberg
logistical challenges of condom supply because of these areas School of Public Health Center for Communication Programs
being in difficult to reach or sparse areas of the country.
(JHU-CCP) provided technical support and oversight at
all stages of the study. Data were gathered by Freshly
In our analysis, we had some limitations which included the Ground Insights (FGI). The authors wish to thank the South
fact that data used in this study analysis relied on self- African National AIDS Council Trust, South African Field
reported sexual behaviour on sensitive issues, such as Epidemiology Training Programme (SA FETP). Appreciation
condom use and HIV and AIDS. Self-reported data are is also given to Dorothy L. Southern for providing scientific
prone to social desirability bias where respondents tend to writing support and critically reviewing this article.
respond to questions in a manner that is viewed favourably
by others. There is the possibility that participants could have
exaggerated behaviour or under-reported undesirable Competing interests
behaviour. It is, however, unlikely that this bias affected our The authors declare that they have no financial or personal
results because assurance of confidentiality and anonymity relationship(s) that may have inappropriately influenced
was given and the questionnaire was administered in a them in writing this article.
consistent manner across the whole sample. A further
limitation is that the survey was cross-sectional in nature, and
hence causality was difficult to establish. To overcome this Authors’ contributions
challenge, we only reported on associations and correlations. P.G.M., K.M., A.M. and L.R.K. equally contributed to the
writing and research of this article.
Conclusion and recommendations

Our study analysed determinants of MSP and nCU and References
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and that a high perception of benefit are common cognitive HIV Communication Survey 2012. 2013. https://www.ccisa.org.za/sites/default/
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results highlight the need to expand on several initiatives incidence and behaviour survey, 2012. Pretoria Hum Sci Res Counc [serial online].
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including prevention efforts and changing cognitive and outputs/view/6871
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sector progress towards universal access: Progress report 2011. Geneva: WHO,
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http://www.sajhivmed.org.za 125 Open Access