Men’s condom use in higher-risk sex: Trends and determinants in five Sub-Saharan countries

This paper examines men’s condom use at last higher-risk sex (i.e., nonmarital, noncohabiting partner) in five sub-Saharan countries: Burkina Faso, Cameroon, Kenya, Tanzania, and Zambia. The two most recent Demographic and Health Surveys (DHS) in each country are analyzed to show trends in various indicators. Condom use is an important way to prevent the transmission of HIV, the virus that causes AIDS. Encouragingly, use of condoms has increased substantially in Burkina Faso, Cameroon, and Tanzania, with smaller increases in Kenya and Zambia. At the same time, levels of higher-risk sex have declined in four of the five countries, although use of a condom at last higher-risk sex remains below 50 percent in Kenya and Zambia. Multivariate analysis shows that higher education is a consistently strong, positive predictor of condom use at last higher-risk sex, whereas higher wealth status is not significant in most surveys. Knowledge that use of condoms can reduce the risk of HIV transmission is a consistently strong, positive predictor of condom use, but urban-rural residence and region are significant only in some surveys. Comparing the two most recent DHS surveys in each of the five countries, there are no clear patterns of change in the predictive strength of explanatory variables. However, there is evidence of widening gaps in condom use by level of education in Cameroon and by urban-rural residence in Kenya. One important policy finding that emerged from this study is that low wealth status is not a barrier to condom use in most countries, but lack of education is