This research report is submitted in partial fulfilment of the Master of Arts in Demography and Population Studies at the University of the Witwatersrand, March 2017 / Background: Evidence shows that circumcised men are less likely to be infected with HIV compared to their uncircumcised counterparts. However, critics have argued that adopting male VMMC as part of the comprehensive HIV prevention strategy might lead circumcised men to believe that they are completely protected against HIV. Consequently, this could cause them to neglect other HIV protective measures, such as consistent condom use. This study investigated the association between male circumcision and consistent condom use among sexually active men in South Africa. Methodology: The analyses were done using nationally representative cross-sectional secondary data drawn from the 2012 Third National HIV Communication Survey. The study sampled a total of 1899 single black men who were sexually active and were aged between 16-55 years. The management and analysis of the data were carried out using STATA version 14. Descriptive statistics were computed to describe the levels of male circumcision and consistent condom use in South Africa, and crosstabulations and a Pearson Chi-square test were used to assess associations between patterns of male circumcision and consistent condom use by selected variables. Bivariate and multivariate binomial logistic regressions were used to examine the socio-demographic determinants of male circumcision, as well as the association between male circumcision and consistent condom use. Results: The main findings showed that circumcised men were more likely (OR=1.18; C.I, 1.171 - 1.182) to consistently use condoms, compared to uncircumcised men. Furthermore, place of residence, education, occupation status and socioeconomic status were positively associated with consistent condom use. On the other hand, men who believed that they would get HIV, and those who were older than 24 years were less likely to consistently use condoms. While circumcision rates were lower in all the provinces compared to the Eastern Cape; Kwa-Zulu Natal and North West had the lowest odds of circumcision of all the provinces. However, both these provinces had the highest odds of consistent condom use compared to all the other provinces. Conclusion: This study found a positive association between male circumcision and consistent condom use. The findings revealed that, contrary to concerns that circumcised men may have a false sense of protection and therefore use condoms less consistently, circumcised men were more likely to consistently use condoms compared to uncircumcised men. There is, therefore, no evidence of risk compensation associated with circumcision. As a result, male circumcision should continue to be rolledout nationally, as part of an effective and comprehensive HIV prevention strategy. On the other hand, it is also evident that HIV prevention education targeting men is crucial, as men who believe that they will get infected with HIV and those older than 24 years need to be encouraged to practice safe sexual and HIV protective behaviours such as consistent condom use. / XL2018

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in Development Studies, 2017 / HIV/AIDS is a social epidemic that continues to impact the lives of countless young people in Southern Africa and possibly poses one of the biggest threats to adolescent health and sexuality; and is one of the main challenges faced by youth in their transition to adulthood. However, despite the fifteenth year running of the South African government’s HIV/AIDS programme, prevalence rates continue to increase annually pointing to disjuncture between government intervention and the causal mechanisms involved in the spread of HIV/AIDS. Furthermore, literature on men’s sexuality in Southern Africa remains embedded within a ‘predatory masculinity and female vulnerability’ paradigm which results in a gendered analysis of HIV/AIDS and a side-lining of the male perspective which then places young men at a high risk of HIV infection. Therefore, in an attempt to understand the disconnect between literature and high prevalence rates; and to contribute to a better understanding of men’s health and sexuality, a qualitative study using focus group discussions and in-depth interviews was conducted amongst young black heterosexual men (19- 25 years old) to discover the factors that determine condom use among young men living in an RDP housing settlement in Daveyton on the East Rand of Johannesburg. The research findings show that condom use in the sample is predicated upon the young black heterosexual men’s definition of masculinity, the nature of the sexual relationship and sexual partner, and – to a lesser extent - the social accessibility of the condom. As they move from adolescence to adulthood, there is a transition of their understanding of masculinity from one characterized by promiscuous sexual behavior where the use of condoms is seen to diminish the degree of one’s masculinity, to a masculinity fostered by responsible sexual behaviour and accompanied by condom use. The study also found that young men expressed a distance from the supposedly hegemonic view of violent masculinity and male dominance in sexual relationships and that the search for love and the ability to provide for one’s partner was what was most valued in young men’s self -conception of masculinity and sexuality. This then negatively impacted condom usage in romantic relationships as such relationships were perceived to contain less risk and it was assumed that they are predicated on trust; positing love as the biggest barrier to condom use. Furthermore, the study found that although condoms are physically and economically accessible, they are not socially accessible due to the stigma attached to sexual activity among adolescents – which results in a barrier to condom usage. Therefore, findings suggest that the government’s condom promotion programmes - based on the tenets of education (on the subject of pregnancy and sexually transmitted diseases) and physical accessibility of condoms - are largely inconsistent with the factors that determine condom use among young men. This implies that there is a need to develop tailored condom promotion programmes targeted at male sexuality / XL2018

This study aimed at exploring perceptions of young adults with regard to condom use in Vhembe district, Limpopo province. With the help of a quantitative, cross sectional descriptive design approach, data were collected using structured questionnaires administered to 372 young adults who came for healthcare services at a selected clinic. The findings indicated that there is a relationship between positive perceptions toward condom use and actual condom use. It means that people who have positive attitudes toward condoms are also more likely to use them. In contrast, people with a negative attitude towards condoms are less likely to use them during sexual intercourse. Negative attitudes of health care providers were found to be the barrier that prevents sexually active individuals to access condoms in primary health care facilities. Re-training of health care providers to address negative attitude is a matter of priority. Mass media can also be used as an avenue to communicate consistent and correct condom use. / Health Studies / M. A. (Nursing Science)

This study aimed at exploring perceptions of young adults with regard to condom use in Vhembe district, Limpopo province. With the help of a quantitative, cross sectional descriptive design approach, data were collected using structured questionnaires administered to 372 young adults who came for healthcare services at a selected clinic. The findings indicated that there is a relationship between positive perceptions toward condom use and actual condom use. It means that people who have positive attitudes toward condoms are also more likely to use them. In contrast, people with a negative attitude towards condoms are less likely to use them during sexual intercourse. Negative attitudes of health care providers were found to be the barrier that prevents sexually active individuals to access condoms in primary health care facilities. Re-training of health care providers to address negative attitude is a matter of priority. Mass media can also be used as an avenue to communicate consistent and correct condom use. / Health Studies / M. A. (Nursing Science)

This study investigated influence strategies used by university students to negotiate condom use. The study examined the seven condom influence strategies (CISs) -withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention- used by heterosexually active male and female students. The sample comprised of 156 first year students (male=44 and female=112). Statistically significant correlations were found among all the condom influence strategies subscales. Results suggest that the university students influence their partners in all identified condom influence strategies and the risk information strategy holds the most promise of all the strategies.

Text in English / The Department of Education nationwide introduced HIV and AIDS care and support for learning and teaching programmes as intervention strategies for supporting vulnerable learners. Despite these interventions, teenagers continue to fall pregnant and this increases their vulnerability to HIV infection. HIV and STIs are rife among teenagers owing to ignorance and peer pressure, among other factors. The aim of this exploratory qualitative study was to explore factors that influence condom use among high school teenagers aged between 16 and 18 in Dutywa District. Focus group discussions and in-depth face-to-face interviews with 12 high school teenagers from one high school (High School X) were used to collect data. Thematic analysis was used to analyse data. The findings of this study revealed that high school teenagers are not using condoms to any significant degree. In their opinion, condoms limit sexual pleasure; they indicate a lack of trust and unfaithfulness between partners and are associated with sexually transmitted diseases. The findings of this study are significant for the policy implementation of schools. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)

Text in English / The Department of Education nationwide introduced HIV and AIDS care and support for learning and teaching programmes as intervention strategies for supporting vulnerable learners. Despite these interventions, teenagers continue to fall pregnant and this increases their vulnerability to HIV infection. HIV and STIs are rife among teenagers owing to ignorance and peer pressure, among other factors. The aim of this exploratory qualitative study was to explore factors that influence condom use among high school teenagers aged between 16 and 18 in Dutywa District. Focus group discussions and in-depth face-to-face interviews with 12 high school teenagers from one high school (High School X) were used to collect data. Thematic analysis was used to analyse data. The findings of this study revealed that high school teenagers are not using condoms to any significant degree. In their opinion, condoms limit sexual pleasure; they indicate a lack of trust and unfaithfulness between partners and are associated with sexually transmitted diseases. The findings of this study are significant for the policy implementation of schools. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)