Individual- and community-level factors affecting condom use during high risk sex in Zambia: Perceptions, norms and behaviors

This paper examines how perceptions and norms of individuals and community leaders on issues related to sexual behaviors may influence condom use at last high risk sex in Zambia.

Methods. Using household and community data from the 2005 Zambia Health Communication Surveys, which were conducted as baseline surveys for the Zambia Health Communication Partnership, we conduct two-level multivariate analyses to examine effects of individuals' and community leaders' perceptions and norms related to sexual behaviors on individuals' condom use at last sex with a non-marital, non-cohabiting partner in the last 12 months.

Results. Two-thirds of the sample (69% of men; 54% of women) used condoms at last sex with a non-marital, non-cohabiting partner. Preliminary analyses show that the following individual-level factors increase the probability of condom use among men: having multiple partners (OR=1.88, p<.05), perceptions of others' approval of condom use (OR=1.36; p<.05), and personal approval of women's suggestion of condom use (OR=1.36; p<01). Community leaders' disagreement that women who carried condoms were “easy” also increased individuals' condom use (OR=2.20; p<.05). Among women, the following factors increase the likelihood of condom use at last sex: perceptions of normative condom use in the community (OR=4.31; p<.001), and community leaders' disagreement that women who carried condoms were “easy (OR=2.89; p<.05).

Discussion. Our findings suggest interventions should promote individuals' perception of condom use as a normative behavior for both men and women. Community-based efforts should aim to strengthen positive attitudes towards condom use among community leaders as well as the public.