Trends in condom

A review of the literature reveals that condom use is influenced by social and demographic characteristics, knowledge about reproductive health, self efficacy and attitude towards condom, issues of access and affordability (51). The mentioned factors altogether when integrated is likely to promote condom use among individuals. However, consistent and correct condom use play a great role in prevention of HIV infection and unwanted pregnancy (19). Use of condom even once is one step forward but for effective HIV prevention consistent and correct condom use is mostly encouraged. Moreover, the measures most documented in many studies as indicators of condom use are condom use during the first sexual intercourse, condom use at last sexual encounter, consistent condom use and lifetime condom use (17). While lifetime condom use provides important information, it is the determinant of consistent condom use that would be most important

We found proportions of pupils (who have had their sexual debut) that reported to have had ever used a condom increased from 2001 to 2006 (n.s.). Despite this noted improvement in proportion that reported to have ever used a condom from 2001 to 2006, generally the proportion of sexually active females and males reporting to have ever used a condom was relative low. Suffice to say the magnitude of the increase in condom awareness is not adequate to create the public health effect needed.

For example although in our study the proportion of participants who knew what condom is increased, but very small percentage of sexually active participants reported to have ever used a condom. Moreover, the proportions of participants who have ever used condoms in our study are relative higher compared to the findings from a population-based survey in Arusha and Kilimanjaro, Tanzania indicated 17% of older adolescents (15 through 19 years old) had used condom at least once (73). Short period of interventions as well as inadequate supply and negative perception of condoms may explain this low proportion.

Three months intervention is a short time for a persistent change of behaviour although previous studies in Tanzania had similar length of intervention (36;38). However, this little increase in condom use in 2006 reflects changes among pupils in attitudes about condoms. The results from a recent published study in Tanzania agree with our argument that program needs time to impact necessary changes among targeted audience(74). In that study knowledge of HIV and condom use were found to improve after three years of intervention. Additionally, a study in South Africa had two weeks intervention and proved this to be very short time span to develop the desired extent of active participation of program recipients (75). Two weeks was relatively short time as compared to long interventions of nine months from a study in South Africa (41).

However, the fact that reported condom use in our study increased in 2006 (after a decline in 2004 and 2005), the year that no intervention was done, can be explained by effect of time. Because of the influence of public campaigns against HIV and AIDS from media the effects of the program gets better again. As HIV epidemic is getting older and older, awareness of condoms increased.

Our argument is supported by findings from one study conducted from northern Tanzania that primary school children from that area have been exposed to several sources of HIV and AIDS

The findings of our study indicated that generally condom use was low for both sexes although, no statistical significant difference was demonstrated among either sexes in all age groups. From prevention point of view these findings suggest existence of increasing risk for HIV infection among primary school pupils. For the program efficacy for future research this implies more efforts should be done to improve condom use for both sexes. However, although significance difference was not attained across all age groups, more males in our study reported to have ever used a condom than females in their respective age groups. Results from a study among 9-24 years pupils in Uganda reported significantly intention to use condom increase among the participants as age increased. Since intention to use condom has been found to correlate with actual condom use it is very correct to say proportion of condom use increase as age increase (37). These findings call for a need to intervene in line with the above mentioned factors in this section that may contribute to low condom use among pupils and therefore increasing protection against HIV through condom use remains a public health priority.

Self efficacy in condom use was found to be one of the important factors influencing condom use among pupils (50). In this study substantial proportion of participants in all age groups reported it was or it will be difficult to use condom when having sexual intercourse. This reflects difficulties in using condoms which may lead to incorrect use of it when having sexual act. Lack of correct use of condoms may be as good as not using it, hence risk of HIV infection. It is important however, to note that self efficacy towards condom use appeared to be the strongest predictor of consistent condom use (77). Results from a recent study from South Africa identified important factors influencing condom use which were: students’ self efficacy to use condoms, skills training in obtaining, carrying, negotiating condom use and the confidence to correctly put on and take off a condom can improve students condom use self efficacy and encourage consistent condom use (50).

This suggests that pupils with a high level of perceived self efficacy on condom use are more likely to use condoms consistently than those with a low level.

Skills on condom use are important to ensure correct condom use for better results in prevention of HIV infection. These skills have to be taught by teachers for this case and adapted by the users in a long run. However, Findings from evaluation of numerous studies reported that teachers and school authorities tended to inhibit demonstration of condom use in the classes for the reason that it will initiate sexual acts among pupils. Moreover, in those programs teachers did not use the materials on condoms provided and omitted any such information stemming from the programs

in using condom may be contributed by teachers’ negative attitude towards condom. Overall, these findings suggest a need for teachers to have a positive attitude towards condoms, teach skills on condom use and not only provide information.