Transitioning from deviance to acceptance of youth condom use: Qualitative findings from rural Kenya

In Africa, comprehensive (not abstinence-only) adolescent health programs generally include information on condom use and incorporate skills-building such as condom negotiation. Yet even when HIV prevalence is high, rural communities have been ambivalent about youths' use of condoms. To understand community norms about youth condom use and identify transitional views, 31 focus groups (310 people altogether) were conducted with students, peer educators, parents, teachers, church leaders and health providers in Bungoma district, Kenya, in 2005. The majority of participants considered youth condom use deviant and many would punish youths found with condoms. The main reasons for opposition to condoms were: youths' motivation (to have “love affairs”); youths' premeditation (planning ahead) for sex; youths' risk compensation (more sex because no consequences); youths' immaturity; the condoms' physical qualities (have holes, can burst); and the situation (school grounds should be inviolate). However, a significant transitional view was found to be emerging. Many community members were inclined to permit or promote condom use if youths' motivation was for protection, if youths were carrying condoms for “emergencies,” if youths were sufficiently “mature,” if youths behaved responsibly and educated others, and if youths avoided sex on school grounds. Those most oppositional were parents, church leaders and primary students; those most permissive were health providers and secondary students. Peer educators were less permissive than other secondary students. The implications of these findings for improving community support for comprehensive youth HIV prevention programs in Africa—such as demystifying condoms and promoting “responsible” youth condom use—will be discussed.