'It's not good to eat a candy in a wrapper': male students' perspectives on condom use and concurrent sexual partnerships in the eastern Democratic Republic of Congo

Understanding adolescent girls' experiences with accessing and using contraceptives in Zambia

BACKGROUND

Globally, the unmet need for contraception among adolescent girls is high and is driven by barriers to access and utilisation of contraceptives. Understanding adolescent girls' experiences with accessing and using contraceptives is crucial because it influences their decision to use and willingness to continue using health products and services. While determinants of contraceptive use have been extensively researched globally, few studies explore how adolescent girls experience contraceptive use in Zambia using qualitative methods. Therefore, this study aimed to understand Zambian adolescent girls' experiences using contraceptives.

METHODS

Thematic analysis was used to analyse data generated from 7 focus group discussions and three in-depth interviews with adolescent girls aged 15 to 19 years in 4 districts in Zambia. NVivo version 12 pro (QSR International) software was used to manage and organise the data.

RESULTS

Results revealed that adolescents' experiences concerning contraceptives across the continuum of care are shaped by various factors, including knowledge of contraceptives which comprises sources of information and contraceptives; experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives; perspectives about existing contraceptives; and preferred types of contraceptives.

CONCLUSION

The multifactorial interaction relating to adolescents' personal experience, their community and the environment in which they access contraceptive services all contribute to their overall experience and influence their contraceptive decisions. Therefore, qualitative studies exploring adolescents' experiences with accessing and using contraceptives are vital for tailoring interventions responsive to the contraceptive needs of this age group.

Adolescent condom use in Southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators

BACKGROUND

Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group.

METHODS

This review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a 'best-fit' framework synthesis approach.

RESULTS

We coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors.

CONCLUSION

SRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.

Premarital relationships and condom use among young people in Suva, Fiji

Background Young people in Fiji experience high rates of sexually transmissible infections and early pregnancy. Despite being identified as a key priority group in national strategies, little is known about use of condoms among young people in premarital relationships. This study aimed to enhance understandings of premarital sex and condom use practices among young people in Fiji.

METHODS

Focus group discussions with 33 young women and men aged 18-29 years and 17 interviews with young women aged 18-26 years in an urban setting in Fiji were conducted. Inductive thematic analysis examined condom use practices.

RESULTS

Participants described a range of contextual influences inhibiting or enabling condom use. Factors inhibiting condom use included sociocultural expectations regarding premarital abstinence; young people's engagement in hidden sexual relationships; limited intergenerational dialogue about sexual health issues; judgmental attitude of staff at condom access points; male dominance of condom use preferences; and belief condoms disrupt intimacy, reduce sexual pleasure and infer a lack of trust. Factors that enhanced condom use included accessing condoms through discreet methods; adult beliefs that supported safe sex practices; and refusing to have sex without a condom.

CONCLUSION

Findings broaden understandings of young people's condom use practices in Suva, Fiji. The findings illustrate the need for culturally appropriate youth-centred sexual and reproductive health (SRH) programs and services. Specific strategies that might enhance young people's condom use include community- and youth-led responses; peer condom distribution; provision of condom dispensers in community settings; scaling up of youth-friendly SRH services; and the delivery of comprehensive sexuality and relationships education.