Gender Norms and Structural Barriers to Use of HIV Prevention in Unmarried and Married Young Women in Manicaland, Zimbabwe: An HIV Prevention Cascade Analysis
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study demonstrates that negative gender norms significantly constrain adolescent girls and young women’s (AGYW) motivation and capacity to use condoms for HIV prevention in Zimbabwe, particularly among married AGYW. While traditional norms around premarital sex and condom use are weakening for unmarried AGYW, married AGYW face deeply entrenched expectations that hinder condom use within marriage. Norms regarding partner fidelity, community acceptability, and perceived risk strongly shape AGYW’s HIV prevention behaviours, highlighting the critical need for structural and social norm-focused interventions.
Objectives The study aimed to examine how gender norms and structural factors impact AGYW’s use of condoms for HIV prevention in Manicaland, Zimbabwe, and how these influences vary between unmarried and married AGYW.
Methods A population-based survey was conducted in eight communities in Manicaland between July 2018 and December 2019. Data were collected from 9,803 participants aged 15 and above, including 2,122 HIV-negative AGYW. The study used HIV prevention cascade (HPC) frameworks to assess motivation, access, and effective use of condoms among unmarried and married AGYW at higher risk of HIV. Logistic regression was employed to identify associations between perceived social norms and condom use behaviours.
Results Motivation to use condoms was lower in married AGYW (43%) than in unmarried AGYW (86%), and actual condom use at last sex was significantly lower among married AGYW (4.3%) compared to their unmarried peers (61.5%). Negative community and peer norms—especially perceptions that friends do not use condoms—were strongly linked to lower motivation and use among unmarried AGYW. For married AGYW, social norms discouraging condom use in marriage, low perceived HIV risk, and poor negotiation skills were key barriers. Stigma related to pre-marital sex and HIV, as well as intimate partner violence, further constrained access and capacity for effective condom use.
Conclusions Social norms significantly influence AGYW’s condom use, with distinct patterns by marital status. While norms opposing premarital sex are weakening, persistent stigma and disapproval around condom use—especially within marriage—pose major barriers. Addressing these norms is essential for effective HIV prevention.
Social Norms Key Take-away Shifting social norms—especially those normalising condom use in marriage and challenging stigma around female sexuality—are critical to improving AGYW’s access to and uptake of HIV prevention methods. Interventions must be tailored to marital status and should engage communities in dialogue to transform harmful gender ideologies and peer influences.
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