One of the behavioural change indicators is increased condom use which is view as one of the main strategies for combating the spread of HIV and secondary sources revealed that the main objective of the ZNASP 2006 -2010 under condom distribution is to make more widely available both re-branded public sector and socially marketed condoms in rural and remote areas. Condom promotion and distribution is spearheaded by both the public sector, the Ministry of Health and Child Welfare and the Zimbabwe National Family Planning Council (ZNFPC) and civil society organisations such as the Population Services International (PSI). The National Female Condom Strategy 2006 to 2010 was also developed and is currently being implemented.
Condom procurement and supply is done by ZNFPC, which carries out systematic forecast of condom consumption needs. All procured commodities are assessed for quality by the Medical Council of Zimbabwe and all commodities that fail the test are destroyed.
Distribution of commodities is through a Delivery Team Topping-Up System (DTTU), where visits are made bi-monthly to health facilities for replenishment of commodities according to consumption data108.
107National HIV/AIDS/ STI/TB Council, Zambia in AIDS Matters. No. 78, 2009.
108ZNASP 2006-2010 MTR, July 2009
In the early 1980s, Zimbabwe became one of the first countries in the Sub Saharan African region to implement programmes to manage sexually transmitted infections, and condom distribution began in the early 1990s, steadily increasing over the years. Then, the public sector was the principal provider of male condoms but today, the international non-Governmental organizations now account for more than a half of all condoms distributed.
The fact that most condoms were now purchased rather than freely distributed, makes it more credible that people really do use them.
It is worth noting that despite high levels of knowledge about condoms in Zimbabwe, statistics from the Zimbabwe Demographic Health Survey (2005-2006) reports show that on a national level, only about 16.4% and 43.7% of women and men respectively aged 15 – 24 years used condoms at first sexual encounters109 Additionally, repeated studies show that the overwhelming majority of people fail to use condoms consistently and correctly despite appropriate knowledge and education. However, making a comparative analysis with regional countries in Sub-Saharan Africa with high levels of HIV prevalence rates, it is argued that condoms are a huge success story in Zimbabwe where 900 000 female condoms were sold in 2005 alone, the highest sales per capita in the world110.
There are however slight variations when comparing the above Government statistics with the results in our findings. There is no dispute to the fact that the condom use programme was relatively a ‗success story‘ in Zimbabwe. Our research findings suggest that the levels of consistent condom use and trust on it as an effective prevention strategy is decreasing.
109ZHDS, 2006.
110UNAIDS, 2006
Fig 6.3 presents the percentages of the condom users amongst our respondents where 49%
reported never having used a condom during their sexual encounters.
Fig 6.3 Have you ever used a condom?
(Source: Survey Data)
Table 6.10 shows the perception respondents have on condoms as an effective tool for prevention of HIV infection.
Table 6.10 Condoms can effectively prevent HIV and AIDS
Those that reported to have used a condom accessed them through purchasing, freely distributed by prevention advocates or their partners had them despite the fact that only 19% of this group use the condoms consistently every time they engage in sexual
intercourse. It is to some extent a fact that a significant number of Harare residents have considered or actually have changed their sexual behaviour if we apply the commonly used measurement rod of condom use. Through in-depth interviews, searching for behavioural change one young Zimbabwean commented,
“…I am not sure if sexual attitudes are changing altogether, but I tell you around the streets of Harare you will see lots of used condoms on the ground”
However, there are also various reasons of non-condom use including abstinence, being faithful and trusting partners in particular those that are married. Others do not believe the effectiveness of a condom, whilst some reported having used them once and did not like them at all. Only 19.6% of respondents that do not use condoms intend to use them in the next 12 months despite the fact that almost everyone interviewed (93.4%) knew where to get the condoms if they happen to need them. When given a scenario to test their attitude on condom use, nearly 60% reported that should an opportunity of having sex arose without a condom, they would let it pass until they secure a condom.
Despite repeated media warnings about the association between unprotected sex and AIDS transmission, there are indications that consistent use of condoms is not a typical practice for large numbers of the sexually active. It is universally acknowledged that consistent and careful condom use is a far more effective method of reducing HIV infection than is reducing the number of sexual partners. Therefore, changing sexual practices, and particularly convincing people to use condoms every time they have intercourse has become a central goal of AIDS prevention and educational programmes. Most programmes have focused on bringing about individual behavioural change.
Among heterosexuals, condoms are considered methods for birth control rather than a means for preventing sexually transmitted diseases. Therefore, sexually active couples tend to use other forms of contraception, such as birth control pills, hence increasing the risk of exposure to AIDS. The in-depth interview with the Zimbabwe Aids Network informant suggest that married women are now able to address condom protection with husbands indirectly, through discussion of family planning for the welfare of children. The wives are careful not to bring up the subject of infidelity; instead, they talk about preventing pregnancy in view of the economic hardships involved in raising the children they already have. The danger comes when the husbands insists on the wives to take contraceptive pills or having the injection instead of using condoms.
One of the significant hindrances to the faithfulness strategy is that some evidence points to the deterioration of the moral fibre in Harare as evidenced by the sprawling of brothels and night spots and increases in the number of commercial/casual sex workers (CSWs) on the streets. The deteriorating economy is also to blame for the increased prostitution as more and more women are becoming vulnerable by the day. A 2006 study carried out in Harare revealed that the majority of the CSWs (90%) were single mothers and divorcees111 (IDS, 2006). What is encouraging however this that the majority of CSWs are not afraid of insisting on condom use, a practice not common among married women. The focus of vulnerability is gradually shifting to the marriage institutions given the fact the just over half of the respondents agree that it is acceptable for a woman to bring a condom in a sexual relationship, as discussed below:
111Institute of Development Studies, 2006.
More recently, the medical community has begun shifting from the condom approach and placing a greater emphasis on risk-avoidance techniques. AIDS educators often publicly promote approaches that would not be normally met in real lives, such as the notion that it is acceptable for our spouses or children to have multiple partners, provided condoms are used. What is interesting to note is that the issue is not whether the condom do or do not protect against AIDS, but about the sort of culture which ‗condomisation‘ promotes, and the sort of people we become as a result. Condomisation becomes a metaphor for incursion of postmodern culture in Africa. This has not been received very well in the African context as the following statement suggests:
„Teaching our children to use the garment of whoredom (condom) that was designed by the
"whiteman" to promote fornication amongst their kindred is not the answer to HIV and AIDS in Africa.
Have you not seen the town's most notorious harlot pregnant often. Were there no garments of whoredom to put on while whoring? The garment of whoredom is often put on once or twice and the third time there is already some fake degree of trust between the fornicators. So nomatter how many of those garments you litter in all public toilets, people will catch AIDS and other diseases of the bed. The answer is the return to Unhu/ubuntu - African cultures of our fathers and leave fornication alone. If we grill our children in Ubuntu, none would die of AIDS, there is no wisdom in giving children freedom to die. Children do not know anything, we need to force that on them. Also we need to be more strict with our women as African culture has done for years because if they do not open it means no fornication (Katangole ,2000).
In conclusion, whilst prevention messages regarding correct and consistent condom use as an effective method against HIV are highly important, most participants are aware of this and are still not using condoms. These results suggest there may be other important factors that may explain lower condom use amongst Harare residents. However, the
perception that condoms make sex less enjoyable was the correlate most strongly associated with lower condom use. These findings suggest that it would be beneficial to focus future researches on reasons why condoms make sex less enjoyable, including the physical characteristics of a condom that discourages use.