The new study shows that South African women under 26 years old were more likely to have used a condom in their last sexual encounter if they held more gender equal views, while those who had a more male dominant perspective were less likely to have done so. However, the gender norms of women who were 26 years or older and men of all ages did not appear to have an impact on condom use.

“Gender norms are social and cultural constructions of the ways that women and men are expected to behave,” says the University of Southampton’s Dr Nuala McGrath who co-authored the study, which has been published in the journal PLoS One. “For women, gender norms can reinforce their unequal position in a relationship and in wider society – this could reduce their ability to refuse sexual advances and to negotiate safer sexual practices, including condom use.”

Conducted in KwaZulu-Natal, an area of rural South Africa with the highest prevalence of HIV amongst adults, the study involved 530 sexually-active HIV-positive women and men. While attending a clinic for HIV care, study volunteers were asked about their views and experiences of gender norms, relationships, sex and HIV disclosure, as well as about their socio-demographic and socio-economic status.

The team found that a higher level of education corresponded to more equitable gender norms amongst both women and men, and that this was associated with higher condom use in their most recent sexual encounter amongst women under 26 years old. In partnerships reported by women, experience of having ever used a condom and condom use during first sex were also associated with more equitable gender norms.

The findings also show:

Women were more likely than men to have had a partner insist on having sex when they didn’t want to, while having unwanted sex with a partner reduced the odds of condom use at last sex among women.

Higher levels of perceived stigma of HIV meant women were less likely to have used a condom the last time they had sex.

Significantly more men than women reported knowing their partner’s HIV status.

HIV-positive women and men who disclosed their HIV status to their partner and who knew their partner’s status were significantly more likely to have used a condom at last sex.

Dr McGrath comments: “Although partners HIV status didn’t seem to have an impact on condom use, knowledge of a partner’s status was an important factor, suggesting that communication between partners plays a critical role in safer sex.

“Gender equality should be incorporated into interventions targeting both women and men and this must be supported by efforts at a societal level.”

Faculty of Medicine