Worms, condom effectiveness and self-efficacy: Condom beliefs and other determinants of willingness to use condoms among a seminomadic tribe in East Africa

Background: Condom use is effective in preventing HIV transmission, and condom promotion is an integral part of HIV prevention models worldwide. Researchers in Tanzania, South Africa, and Namibia have found rumors that negatively reflect on condoms, such as the belief that condoms contain worms.

Methods: Study data comes from a cross sectional cluster-randomized survey (n=370) representing adults from the Maasai tribe in two rural districts in Northern Tanzania. A series of in-depth and cognitive interviews informed development of survey items. The survey had a response rate of 91%, and analyses are conducted with probability weighting to account for complex sampling and survey design factors.

Results: In univariate analyses many respondents subscribe to negative rumors about condoms, and rumor belief was associated with decreased willingness to use condoms. A majority agree with statements that condoms contain worms (53%), condoms have holes (56%) and condoms cause HIV (53%). The multivariate logistic regression model assessing willingness to use condoms observed that positive beliefs in condom effectiveness (condoms work successfully OR=14.04) are associated with willingness to use condoms, while rumor beliefs (condoms have worms OR=0.07) are negatively associated with willingness to use condoms.

Conclusions: Future condom promotion interventions should consider reinforcing beliefs in condom effectiveness as well as addressing negative rumors surrounding condoms. Further research needs to be undertaken to determine the association between these factors and condom use in areas where use of condoms is more prevalent.