Writes Key Correspondent, Chrispin Hangombwa.
Condoms are still the most effective barrier to HIV transmission and other sexually transmitted infections as well as preventing unplanned pregnancies. Comprehensive condom programming integrates various activities including male and female condom promotion.
Condom promotion and other HIV prevention strategies used synergistically towards a common goal, offer the greatest potential for achieving the maximum overall impact on reducing HIV transmission (UNAIDS report June 2004).
Condom promotion has been rolled out in most of the countries in the world and both male and female condoms provide options to both sexual partners.
A focus group discussion with four different groups of married couples between the ages of 20 and 40 years old was recently held. It aimed to assess the level of condom use among married couples. These groups were from different areas: Chawama Health centre, Kanyama Health centre, George Health centre and Kabwata Health centre. Each group was composed of 10 couples.
From my own assessment, both groups had adequate information about the availability of condoms, both male and female, but there was another issue from all interviewed couples.
It is a common belief that when people marry, they marry in order to have children but some marry for the sake of getting together and enjoying sex. Most couples who I talked to felt it was not necessary for a married couple to use condoms because it was against their culture and that condoms were there to be used by men and women in their extra marital affairs. The couples I discussed this with were sexually active.
In most cases, women are more willing to use condoms but they find it difficult to introduce the topic of condom use to their spouses for fear of being victimised as promiscuous, as it is taboo for women to ask for sex from their spouses in African culture.
Some men said they would want to use condoms with their spouses for family planning purpose but each time they tried putting on a condom, they lost their erection.
Some men strongly felt that condoms could only be used with prostitutes and not with their partners because marriage lost its purpose with condom use. They said they preferred their wives contraceptives as both the male and female condoms were not 100% reliable.
Condoms are about 90% effective when used correctly and consistently. If the risk of transmission was one in 500 sexual acts without a condom, it would be reduced to one in 5000 when a condom was used (UNAIDS Report June 2004).
It is common knowledge that when a couple has not taken a step to know their HIV status through voluntary counselling and testing, they seldom use condoms because they always assume that all is well since they are married. Therefore, fears about contracting HIV or STIs do not apply to them. The HIV prevalence rate is higher with married couples than with people who are not married.
A study which was done in Ndola, Zambia, in 2004 indicated that married couples aged 15 to 19 years old were found to have higher levels of HIV infection than non-married sexually active males and females of their age. This demonstrates that not only is marriage not protective in some settings, but it can actually increase risk (UNFPA/UNAIDS Report, June 2004).
Some men are craftier as they have a habit of going home very late so that they find their spouses fast asleep. In such circumstances, they go straight into the sexual act without a condom such that when the spouse is aware of what they are doing, the man would have already gone a mile into the act without a condom.
Culturally, married women are told not to sleep in their night wear. As a result, women find it very difficult to protect themselves from such kinds of behaviour from their spouses.
Some couples agree that using condoms reduces sexual pleasure for both male and female, citing an example of one eating a sweet with a wrapper on. How can one enjoy the flavour the sweet, they say.
Men will always find all sorts of excuses when it comes to condom use with their spouses because they know that they cannot be challenged by their spouses, especially with tradition and culture in tow.
According to a number of clinics, including the Planned Parenthood Association of Zambia, the good news is that there is more demand for female than male condoms from married women. This could either mean that women are convincing their spouses to use female condoms or using them without the knowledge their spouses.
Finally, most married couples do not use condoms for fear of breaking their marriages, not even a man or woman will propose to introduce a condom use in their home for sake of preventing STIs or HIV, even when the risk is clearly high.
In my view, married couples should protect themselves from contracting HIV/AIDS and STIs by adopting preventive measures which they accept and are comfortable with. And married couples should be encouraged to access couples counselling services.
Young people, meanwhile, accepted that condoms protect against disease as well as unwanted pregnancy. They spoke of how they faced discrimination from society as a whole when youth and condom use came to light and wondered why ‘adults’ were in denial when they knew that the youth were sexually active.
“A number of my friends got pregnant and dropped out of school for a while” said one. She narrated how some of her friends had to leave school for at least a year to give birth and look after the baby before getting back to school while others ended up getting married instead.
‘If you cannot abstain, use a condom’ said the youth. They talked about how easier it would be if sex and condoms were openly discussed with them so that they were given choices to make decisions. They said they knew sex before marriage had its consequences hence them protecting themselves.
“You cannot come and lecture me and tell me to abstain when you don’t know my background and whether or not I am having sex”, said a 22 year old.
“Some people are sexually abused; some have sex early and so on and so forth. Therefore, choices on whether one should protect him or herself or abstain should be available” he said.
This was amongst a group aged 17 to 24 years old, some of who were in secondary, college and university education and some who were not.