Predictors of condom use at first sex among South African adolescents
Abstract
Background: South Africa as one of the countries with nearly half adolescents living with HIV, has the highest prevalence rates in the world among adolescents. The main mode of transmission in South Africa is through unsafe and unprotected heterosexual intercourse by not using condoms at sexual debut. Thus, there is the need to identify factors associated with condom use at first sex to inform future intervention programmes. Objective: To determine factors influencing condom use at first sex among South African adolescents in 2012. Data and methods: Secondary data covering a cross sectional study involving 1628 males and 1687 females adolescents between 15-19 years interviewed in the 2012 South African national HIV prevalence, HIV incidence, behavior and communication survey (SABSSM) were used. A multi-stage, stratified and clustered probability sampling technique was used. Univariate and multivariate analysis was done using chi square test and logistic regression models, respectively. Results: The prevalence of sexual behavior among adolescents who have had sexual intercourse during the 2012 SABSSM survey was 33.90% among male adolescents and 35.50% among female adolescents. The results indicate that 28.9% of the males and 29.7% of females did not use a condom the first time they had sex. There was an association between broad socio- demographic factors and condom use at first sex, particularly racial group, level of education and place of residence (P<0.05). Generally, condom use at first sex among adolescents was slightly lower among female adolescents than male adolescents. Multivariate regression showed that alcohol use predicted condom use status among adolescents at first sex (OR 1.824; 95%CI 1.312-2.535). There was a significant response relationship for adolescents engaging in sexual intercourse for the first time with a sexual partner more their ages (P<0.05). No access to media sexual content exposure through televisions (OR 1.593; 95%CI; 1.089-2.329) and no access to internet connection (OR 1.821; 95%CI; 1.265-2.621) influenced non-condom use at first sex among adolescents. Conclusion: There is a strong association between adolescent's level of education, age of sexual partner, media content exposure and alcohol consumption status. Health programs, educational programs and HIV prevention programmes need to use media platforms that could reach adolescents specifically those in rural areas and those in lower grades in addressing issues of early sexual debut and non-use of condoms at first sex among adolescents. This could prevent and disentangle the association between adolescents early sexual debut and association of non- condom use at first sex.
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