Condom literacy, self-efficacy, and HIV-risk behaviors: a cross-sectional analysis of adolescent girls in northwestern Botswana
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Although gender and relationship norms were not independently associated with girls’ perceived ability to insist on condom use after adjustment, the discussion emphasizes that patriarchal beliefs about male power in sexual relationships may still impede girls’ ability to translate condom-use intentions into behavior. A notable minority of girls endorsed beliefs that normalize male sexual entitlement, coercion, or violence. The authors therefore argue that interventions should address these gender-inequitable beliefs alongside strengthening girls’ communication, bodily autonomy, and condom-use self-efficacy, particularly before sexual initiation.
Objectives The study examined factors associated with adolescent girls’ perceived knowledge of correct condom use and their ability to insist on condom use consistently, with the goal of identifying opportunities to strengthen safer sexual practices among both sexually experienced and sexually uninitiated girls in northwestern Botswana.
Methods This cross-sectional study analyzed self-reported data collected in 2021 from 306 school-going girls aged 14–19. Participants completed tablet-based surveys assessing HIV and condom knowledge, sexual behaviors, condom-use self-efficacy, relationship attitudes, and gender-related normative statements. Social norms-related measures included attitudes toward whether girls can suggest condoms, whether suggesting condoms signals distrust, perceived acceptability of adolescent sex when condoms are used, perceptions of friends’ condom use, and statements concerning gender roles and male power in relationships. Descriptive, bivariate, and multivariate logistic regression analyses examined factors associated with perceived correct condom-use knowledge and ability to insist on condoms.
Results Only 15% of participants reported having had sexual intercourse. Girls without sexual experience had substantially lower odds of reporting correct condom-use knowledge, while girls who knew there was no cure for AIDS had higher odds of reporting such knowledge. Girls unaware of their HIV status had substantially lower odds of reporting that they could insist on condoms. Confidence in suggesting condoms, communicating with partners about condoms, using condoms consistently, and refusing sex when a partner refused a condom were important correlates of perceived ability to insist on condom use. Relationship attitudes were not significant after controlling for other factors.
Conclusions HIV prevention efforts should strengthen girls’ HIV and condom knowledge, communication with partners, and capacity to insist on condom use. Building condom-use self-efficacy among girls before sexual initiation may be especially important for establishing correct and consistent condom use from the first sexual encounter.
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