Young men are vulnerable for contracting HIV infection due to a tendency to engage in unprotected sexual intercourse [1
]. A national youth study found that two-thirds of youth aged 15–24
years had used a condom [2
] and 33.5% of men reported consistent use with the most recent partner, compared with 35.1% inconsistent and 31.3% never use [3
]. Studies undertaken to understand patterns of condom use have often focused on women’s experiences [4
], but understanding men’s experiences is also important for informing HIV risk reduction and developing strategies for engaging men and boys in the fight against HIV. Interventions that seek to promote condom use among women often fail to do so because men control condom use[4
]. Thus male power in relationships is pertinent in determining safer sexual behaviour and significantly influences HIV risk. South African research on HIV prevention indicates that gender inequity in relationships greatly limits women’s safer sexual practices [5
] and greater male power in sexual relationships accounts for much of the spread of HIV amongst women [7
]. Understanding what factors influence men’s ideas and practices related to condoms is valuable for explaining why men do not use condoms.
Non-condom use, as well as inconsistent use, among men cannot be attributed to a single factor. A complex web of factors influence why some men have never engaged in protected sex and why, among those who have, condom use is inconsistent. Following the principles of the ecological model[11
], condom use is influenced by dynamics operating on multiple levels, that is, individual factors, the relationship dyad, family, peers and community/societal contexts within which individuals live. At the individual level lower perceptions of personal HIV risk [12
] have been associated with non- and inconsistent condom use. At the dyad level, condoms may be seen as interruptive agents against trust and intimacy and sexual pleasure experienced [12
]. Studies show contradictions in condom use depending on the status of a relationship: while it can be uncommon with main partners, there are instances where use is also inconsistent with casual partners [14
] albeit the perception of its appropriateness in casual rather than main sexual relationships [15
]. At a community/societal level, men who share conservative ideas about gender, such as notions and practices that uphold views about male superior status over females, anti-femininity and male hypersexuality, seldom use condoms [16
]. Yet, consistent condom use is possible when there is high gender equity and less conflict in relationships[7
]. Since South African research indicates that many young men have used condoms at least once in their lives [18
], the study seeks to explore why consistency of use is not the norm.
Conservative gender norms, roles and attitudes [4
], perpetration of physical or sexual violence against a female intimate partner and other women [19
], transactional sex, alcohol abuse [23
], and multiple concurrent partners [24
] are significant markers of HIV risk. Risky sexual practices of men are also strongly correlated with less gender equitable attitudes [26
]. These ideas about gender greatly influence the formation of masculine gender identities and their role in legitimizing and promoting male ascendancy over other men and women in society, including their partners [28
]. Connell [29
] also refers to the concept of hegemonic masculinity as representing a configuration of beliefs and practices constituting an ‘ideal’ manhood. Hegemony signifies the extent to which one form of masculinity dominates over other (alternative) masculinities, and exists with the simultaneous consent and participation of other non-hegemonic forms. Connell maintains that although not universal, hegemonic masculinity evolves over time, adapting aspects of other masculinities to reinforce its dominance over them, and performing an array of both potentially constructive and destructive traits. On their own, ideals of manhood are not all harmful, however in the era of promoting HIV prevention and gender equity, certain elements of male ideology are a cause for concern, for instance, male toughness and virility are offset against expectations that men fulfill the protector role and can translate into risky sexual and anti-social practices. Moreover, hegemony is not regulated by violence, yet violence can be used in the assertion of the notions of being a man in certain settings [28
]. In the South African context, authors have argued that male toughness, perpetration of violence, acquisition of many sexual partners, and even non- or inconsistent condom use flow from hegemonic masculinity [30
], with its demonstrations of male control over female partners and heterosexual prowess. Men who aspire to embrace hegemonic masculinity are more likely to support and engage in these practices, and form an important group on which to focus reducing HIV risk reduction efforts. It is not always clear how condom use is influenced by men’s gender attitudes and behaviours, thus it is appropriate to investigate how ideals of masculinity may influence young men’s condom use behaviour, and in turn, to reflect on whether changes in ideals of masculinity have potential for reducing HIV risk.
In this paper we examine the hypothesis that the nature of male gender identity influences patterns of condom use amongst rural young men living in the Eastern Cape, South Africa. We will examine the associations between aspects of gender and relationships and violence and risky sexual practices, and three categories of condom use, that is, inconsistent condom use in comparison with consistent and non-condom use.