Condom Use for Preventing HIV Infection/AIDS in Sub-Saharan Africa: A Comparative Multilevel Analysis of Uganda and Tanzania

Unprotected sex remains the primary mode of HIV transmission in sub-Saharan Africa, according to the current study. The authors examined the influence of community-level factors, including health care programs and services, on condom use to prevent HIV infection among men and women in Uganda and Tanzania, countries where other studies have shown improvement in HIV/AIDS knowledge and changes in risky sexual behaviors.

The authors used three types of data to measure individual-, household-, and community-level variables. Community-level data included both community characteristics such as development and economic indicators, and health care services and program indicators. The Demographic and Health Surveys collected such data for Uganda in 1995. DHS collected individual- and household-level data for Tanzania in 1996, and the MEASURE Evaluation Project at the Carolina Population Center collected health care services and program variables for Tanzania in 1996 and community characteristic indicators in 1999. The researchers used multi-level modeling to explore relationships among the variables.

The results showed that condom use to prevent HIV infection was lower among women than men. Condom use was higher for both women and men (10 percent and 31 percent, respectively) in Uganda than in Tanzania (7 percent and 16 percent, respectively). Knowledge of HIV/AIDS was higher in Uganda than in Tanzania, but the level of knowledge was similar for both men and women in each country. Most women and men (more than two-thirds) in both countries perceived themselves to be at risk of HIV, with women perceiving themselves as more vulnerable than men.

Persons living in clusters with higher indicators of development -- like phone and postal service -- were more likely to use condoms to prevent HIV. Condom use was more prevalent in areas with nearby (0-5 km) health care services. Condom use was more common among women (but not among men) who lived in clusters where HIV/AIDS counseling, testing, and treatment were available.

The level of education had a positive effect on condom use for women and men, while marriage had a negative effect on condom use except for men in Tanzania. "Condom use was also found to be lower among Christian women in Uganda and Christian men in Tanzania. The older the women and men, the less likely they were to use condoms in Uganda and Tanzania, while the more children Tanzanian men had, the more likely they were to use condoms," the authors observed. "Level of education was shown to be effective in changing risky sexual behavior, as it serves as a socialization agent by helping women and men to accept modern thinking and seek information that will help them change their sexual behavior. Low levels of condom use among married women indicate how vulnerable they are to HIV infection."

The authors noted, "The negative effect of Christian religion on condom use points to the need for engagement of the religious leaders in the fight against the HIV/AIDS epidemic. Opposition to condom use and condom promotion has been reported in Uganda and Kenya, especially among Roman Catholic groups."