Female Condom Use among Female University Students in KwaZulu-Natal, South Africa: Results of a Randomized Behavioral Trial
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study suggests that brief, group-based female condom (FC) promotion interventions can shift individual-level attitudes and peer norms regarding condom use among young women, even in contexts of entrenched gender inequalities. While broader social norms around male dominance in sexual decision-making remain a barrier, increasing women’s condom self-efficacy and improving peer norms can create openings for greater agency in sexual health negotiations. The findings support the role of peer-based and skills-building approaches in counteracting gendered power imbalances in HIV prevention.
Objectives To assess the efficacy of a two-session enhanced behavioral intervention versus a one-session minimal educational intervention in promoting female condom use and reducing unprotected sex among female university students in KwaZulu-Natal, South Africa.
Methods A randomized controlled trial (RCT) was conducted with 296 Black African female students aged 18–28 years, assigned to either a two-session Enhanced Intervention (EI, n=147) or a one-session Minimal Intervention (MI, n=149). Generalized linear models and generalized estimating equations (GEE) were used to compare changes from baseline to 2.5 and 5 months post-intervention. Social norms-related measures included peer norms around condom use, gender norms related to sexual behavior, and perceived partner attitudes.
Intervention Details Both interventions were group-based and developed collaboratively by U.S. and South African researchers. The MI included a 1–1.5 hour session covering HIV/STI risk, FC use, and gender-based violence awareness. The EI, based on social learning theory, included the same content plus behavioral rehearsal, partner negotiation skills, personal goal setting, and structured practice with feedback. Both groups received free male and female condoms. Peer educators co-facilitated sessions.
Results Both groups significantly reduced unprotected vaginal sex at 2.5 and 5 months, with no significant difference between EI and MI. FC use increased substantially in both arms, as did the percentage of protected sex acts and condom use at last sex. Peer norms and personal attitudes toward FCs improved in both groups, with greater increases in peer norms in the EI group. Gender norms related to male-dominant sex roles were measured but not found to shift significantly.
Conclusions Even a brief, single-session FC promotion intervention can lead to measurable changes in condom use behaviors, attitudes, and peer norms among university women. While structural gender norms persist, interventions that build self-efficacy and leverage peer influence may empower young women to make safer sexual health choices. Shorter interventions may be more feasible and scalable in resource-constrained settings.
Disclaimer: These summaries were generated with the assistance of artificial intelligence and are based on the interpretation of source documents. While efforts have been made to ensure accuracy and clarity, there may be errors or omissions. Users are encouraged to consult the original documents for complete and authoritative information.