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Critical discussion of social and psychological factors underlying the condom use amongst adolescent and young women in Kenya

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Critical discussion of social and psychological factors underlying the condom use amongst adolescent and young women in Kenya

Introduction

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The existence of the condoms goes back to Roman times when they were made out of animal bladders for preventing sexually transmitted diseases (STDs). However, the pieces of evidence of the use of condoms can be found in the 18th century. It is the major non-permanent method used in family planning and is being promoted as a protection against STDs and as a barrier against unwanted pregnancy (Analogbei et al., 2020). Since the 1960s, condoms are being promoted by the governments and international bodies like WHO around the world as an effective, cheaper, and convenient way of preventing unwanted pregnancy and HIV/AIDS. Despite all such factors, Kenya has been among those countries where only 7% of women use condoms during sex which is a quite shocking figure (Davidoff-Gore et al., 2011). Kenya ranks high among nations affected by the STDs, especially AIDS epidemic. It is ranked the third largest HIV cases in the world (Hensel et al., 2012). In 2019, 1.5 million people living with HIV and approximately 4.5% adult are prevalence to HIV that belongs to the age group of 15-49 years. Also, every year 21000 AIDS-related deaths happen in Kenya.

According to Mafirakureva et al (2016), females are more prone to the STDs in comparison to males. About 55% of all adult population having HIV comprises female and the effect is more pronounced under 25 years of age. There is no particular reason behind lesser use of the protection during sex leaving females in Kenya vulnerable to various STDs. However, some researchers have claimed that the role of social and psychological factors is quite significant. Therefore, in the following report, a critical analysis of the social and psychological factors underlying the use of condoms amongst adolescents and young females in Kenya is done. This would comprise different viewpoints to highlight those factors.

Social & Psychological Factors Underlying the Use of Condoms in Adolescent Females

According to Hensel et al (2012), social factors that have a direct or indirect impact on the use of condoms during sex by adolescents and young females are many. These include age, ethnicity, education and literacy level, number of children, marital status, employment factors, and others. These are further discussed individually. 

  • Education and Literacy

The decision-making of young adults as they age gets affected by the education level they attain. It has been acknowledged by Analogbei et al (2020) that those adolescents and young female who had attained education from college were more likely to be motivated to show healthy and safe sexual behaviours. Understanding the process of decision-making throughout early adulthood could facilitate evidence for interventions that promote the development of healthy and sound decision-making. Studies in the past have shown that adolescent and young females might not be competent enough to make a sound decision regarding their sexual health and experiences as they have perceptions of invulnerability (Davidoff-Gore et al., 2011). 

  • Male Dominance & Negative Attitude

Measor (2006) mentioned that males look for dominance during sexual encounters and they desire to control women to attain higher societal and personal status. Many research works have outlined the relationship between control, power, and sexually aggressive behaviour in males. They tend to control the interpersonal decision related to the use of condoms and sex. Thus, chances of unprotected sex are high as women cannot negotiate with men for the use of condoms in such cases.

According to Ngure et al (2012), females and males in the age group of 18-25 years have a very different attitude towards using condoms while having sex. It was revealed in the study there is a perspective among younger people that condoms interfered with sexual pleasure and it is unnatural as well. The satisfaction level of couples reduces for those who use condoms and in many cases, people find it uncomfortable, messy, and irritating. Hensel et al (2012) mentioned that discomfort is the primary reason for the negative attitude of people towards the use of condoms. Analogbei et al (2020) mentioned in their study that if condoms are distributed to people for free, only those couples would emphasis on using them who have had the experience of using them earlier. Also, it was noted down those males' availed condoms more than females.

The use of condoms leads to the decrease in the pleasure of the females to the great extent as reported in a survey in Kenya, where 63% of the women reported that they don't feel the satisfaction levels of sex with condoms as compared to without condoms (Davidoff-Gore et al., 2011). The sex without the condoms is considered to be the purest form of sex as it has full body contact of the couple indulged in the intercourse activity. One of the psychological factors is that the women as well as the men feel that condoms are man-made or artificial and not allow the couples the satisfaction. The benefits of safety from the diseases such as the HIV/AIDS with the use of condoms is overshadowed by the mental perception such as the condoms lead to the decline in the pleasure for the women (Mafirakureva et al., 2016). According to the study, the women also put forward the fact that when the sex involves the use of condoms, the men reach their satisfaction point with the ejaculation but the women remain dissatisfied as they don't feel the natural heat in their genitals as they can feel without the condoms, and remain dissatisfied. The perception is also the long-standing phenomenon that the society is still backward and the use of condoms is not supported by the people, which is translated by the people that sex isn't that good with the use of condoms as it is without using it (Measor, 2006). 

Apart from this, the personal beliefs of the people also have a big role to play in the use of condoms and when most of the population has a negative perception about the use of condoms as there are rumours that the condoms tear during the intercourse and there is also a misconception that it leads to impotency in the women (Randolph et al, 2007). The reason is true that the condoms can tear during the intercourse but the possibility of the event is also very low but the other misconception about the impotence is baseless.

  • Religious Beliefs

Sarkar (2008) mentioned that religions also have a role to play in the use of condoms of their community members. There are different beliefs regarding the use of condoms by youth during sex. There is a belief in Christianity that condoms promote early sexual encounters and adultery in the youth. There are only a few religion that promotes the use of condoms by married couples as a type of contraceptive rather than the protection against STDs. Schick et al (2010) mentioned that religion can have a direct and indirect impact on the use of condoms within and outside marriage. Just by normalising certain beliefs and values or by contributing to the concept of identity of an individual, religion can influence an individual's choices toward the use of condoms. Religions can persuade people's thinking towards and made them see them unnatural and hence, they are not acceptable after marriage. Schick et al (2010) outline that the negative attitude towards condoms' usage amongst unmarried couples in some religion may generate similar behaviour towards the promotion of condoms within the couple. There are pieces of evidence available that outline that African Independent Churches and Pentecostal have banned the use of condoms by the members of the church (Sarkar, 2008).

As some of the religions has a belief that there shouldn't be any barrier in the intercourse as it is a natural process set-up by God and it is considered as a sinful act. Christianity and Islam have a very stringent perspective on the use of barrier such as condoms during the sex. As most of the population in Kenya follows the Christianity and Islam, this also puts a lot of stress on the women who are an ardent follower of the religion as well as their male counterpart don't like to use the condoms during the intercourse (Davidoff-Gore et al., 2011). The societal set-up is one of the biggest factor affecting the use of condoms in Kenya or anywhere in the world, most of the countries which is the majority of followers of Islam, the use of condoms is not supported and the government also don't put efforts to spread awareness in the society that condoms are the safest and the most cost-effective way to control the diseases as well as the population control in the regions as the population in the regions as compared to the Western part of the world is very high (Uchendu et al., 2019). The use of condoms in the west is well supported by the government agencies as the awareness campaigns were run on the huge levels to make the use of condoms by the youths a staple thing, which has also lead to the control on the population as the teenage pregnancies have declined in the country such as the USA, where the rise in the crimes in the 1990s was majorly contributed to the early age pregnancy and the issue of a single mother has led to so much of kids born during the phase in the poverty-stricken neighbourhoods in the USA (Uchendu et al., 2019). The government need to take the awareness campaign to the next level to make the use of the condoms a staple thing for the adolescent population in Kenya, which will help in the control of the population and the diseases also.

  • Marital status

Valente et al (2020) mentioned that a large number of HIV transmissions in the Sub-Saharan regions take place after marriage. The marital status has a huge role to play in the use of condoms among young people. It was mentioned by authors that married couples are older than unmarried people. The use of condoms is more acceptable among unmarried people in the Sub-Saharan regions. Apart from the age, the sexual drive, belief, tolerance of risks, and family obligations can also play a significant role in the acceptance of condoms by married couples and their willingness to use it during sexual encounters. Yosef and Nigussie (2020) mentioned that the perception of HIV status and risks are most likely to transform the decisions of married female and males. Some studies suggest that the HIV status of females may be strongly related to their attitude towards protection during sex. Kenya is one such country wherein women are not aware of their HIV status. Multiple sexual partnerships are one of the prime reasons for rising HIV infection cases in Kenya among adolescent and unmarried young women (Valente et al., 2020). While some females may perceive themselves at a lower risk before marriage concerning the higher risks after marriage, this affects their decision to use condoms during sex. In one of the studies done by the WHO, it was revealed that the HIV infection is highest among younger females who cohabit and those married women who are unaware of the HIV status of the partner.

  • Age Factor

Volk and Koopman (2011) mentioned that adolescent and young females (below 25 years) in Kenya usually experience less power in sexual decision-making due to their younger age. This condition of unequal power during an act of intimacy reduces the ability of females to negotiate whether condoms would be utilised or not. Over half of all new HIV cases in the year 2019 have occurred to females under the age of 25 years. However, the cases of infection among the educated and college-going females are somewhat lower than the rural women (Valente et al., 2020). The age factor is quite significant in the use of condoms during intercourse. Volk and Koopman (2011) supported the fact that the age-based use of condoms has been noticed higher amongst younger females in comparison to older adults. But, these facts are contradicting the findings of the WHO that says the younger adults and adolescents have the highest risk factors for HIV prevalence. Furthermore, as per the WHO, the high to medium risks are associated with the older age groups. Yosef and Nigussie (2020) mentioned that as the age of a person increases, the prevalence of using condoms decreases. An adolescent female has more probability of using condoms but as the age increases, the prevalence of using condoms during sexual encounters decreases.

Valente et al (2020) mentioned that partner's age is also a significant factor that affects the use of condoms. The older partners might have a lower frequency of condom use. Many younger females in Kenya and other Caribbean countries are in a relationship with people of higher age group. This puts them in risks due to their weaker position to negotiate the terms in the relationship. They may have insufficient power to convince their male partners to use condoms during sexual intercourse (Volk and Koopman, 2011). Schick et al (2010) outline that the decision-making process matures for young adults as they grow older.

  • Lack of Awareness in Rural Areas

Volk and Koopman (2011) outlined another factor that could contribute to the low use of condoms by rural women in Kenya and other Caribbean countries. The lack of awareness of condom use and risks of not using it during sex is the prime factor in rural areas. Ngure et al (2012) pinpointed that awareness of condoms among youth is the basis for the utilisation. There is a strong need for creating awareness and providing the right education to rural women about the benefits of using condoms and how it is better than other forms of contraceptive. Among these low-literate young females, the lack of awareness of the risks of unprotected sex may lead to HIV/AIDS risks. However, this does not mean that the consequences of not using condoms need to be exaggerated that may cause unnecessary fear or frighten couples. This might have an ill impact on their sexual performance of couples.

  • Limited Access to Economic Resources

There are many studies available online that suggest that poverty is another factor that limits the use of protection during sex and contributing to the number of HIV/AIDS infection in the sub-Saharan African regions (Valente et al., 2020). Kenya is one such country in which women depends mainly on men to seek financial support. They seek out sexual relationships with males to get access to economic resources. In exchange, they couldn't insist on protections or use of condoms, thereby enhancing the chances of infections. In the case of adolescent and young women, the risks of infection are high as they are dependent on male partners for their economic or materialistic needs (Volk and Koopman, 2011).

Analogbei et al (2020) mentioned that existing research on the impact of poverty and sexual behaviour has utilised the limited measures of individual socio-economic status and household. In some research work, it has been mentioned that higher economic status is associated with the high and consistent use of protection during sex. However, these researches do not provide any information about the access to economic resources to females in the family as an individual. Valente et al (2020) mentioned that the individual-level resources could be the impactful factor in the decision-making regarding sexual behaviour and negotiating terms and conditions related to the use of condoms with males.

Recommendations for the Betterment of the Youth and Adolescent Females

Looking into the most pressing challenges in the use of condoms, some recommendations can be very helpful in dealing with the challenges. The first and foremost recommendation is to develop strategies for the local, regional, and national level to promote the use of female condoms. These strategies must have the intent to enhance the use of condoms and reduce the chances of HIV transmission or any other STDs. Males must be provided safety knowledge and they must be involved in all condom promotion campaigns. This might be useful in dealing with the issue of male dominance and decision-making power regarding the use of condoms during intercourse. Furthermore, government bodies can intervene in the manufacturing of condoms by providing standards or guidelines related to material, size, or shape to make them more convenient, safer, and to increase the confidence of people to use them while having intimacy. Furthermore, women in rural areas need to be empowered to protect themselves and make bold decisions regarding their hygiene and safety. The support is needed to be given to women, especially adolescent and youngsters to overcome the social stigma associated with the use of condoms. They need to be educated about how condoms can protect their reproductive health and their partners as well. NGOs and other social groups need to be trained for this mission. Free condoms must be provided by the Government in rural areas wherein women have very limited access to the economic sources to buy condoms for themselves or their partners. The role of UNFPA is also crucial in promoting the use of female condoms in the poor and developing countries like Kenya and other Sub-Saharan countries. It could train women to protect themselves from the deadly epidemic.

It is suggested to government and different partners to encourage schooling and mindfulness among the country's young ladies. Additionally, making financial opportunities for them can help them in decreasing women's reliance over men and extemporise their situation in arranging and direct their principles too in the sexual relationship.

Conclusion

In the following report, a thorough discussion of different social and psychological factors affecting the use of condoms among adolescent and young females in Kenya has been done. The discussion began with social factors and their impact on the use of protection during sex. The first and foremost was the cultural factor followed by education level, marital status, poverty, age factor, and lack of awareness in rural areas. At last, the role of psychological factors in the use of condoms by females in Kenya has been highlighted. The major problem determined through the complete discussion is the dependency of women on men for their economic needs, low power of negotiation in the relationship, lack of awareness regarding the STDs and other infections, and most prominent of them is the poor literacy and education level.

References

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Davidoff-Gore, A., Luke, N. and Wawire, S., 2011. Dimensions of poverty and inconsistent condom use among youth in urban Kenya. AIDS care23(10), pp.1282-1290.

Hensel, D.J., Stupiansky, N.W., Herbenick, D., Dodge, B. and Reece, M., 2012. Sexual pleasure during condom?protected vaginal sex among heterosexual men. The journal of sexual medicine9(5), pp.1272-1276.

Mafirakureva, N., Dzingirai, B., Postma, M.J., van Hulst, M. and Khoza, S., 2016. Health-related quality of life in HIV/AIDS patients on antiretroviral therapy at a tertiary care facility in Zimbabwe. AIDS care28(7), pp.904-912.

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Ngure, K., Mugo, N., Celum, C., Baeten, J.M., Morris, M., Olungah, O., Olenja, J., Tamooh, H. and Shell-Duncan, B., 2012. A qualitative study of barriers to consistent condom use among HIV-1 serodiscordant couples in Kenya. AIDS care24(4), pp.509-516.

Randolph, M.E., Pinkerton, S.D., Bogart, L.M., Cecil, H. and Abramson, P.R., 2007. Sexual pleasure and condom use. Archives of sexual behavior36(6), pp.844-848.

Ross, Michael W. "Attitudes toward condoms and condom use: a review." (1992): 10-16.

Sarkar, N.N., 2008. Barriers to condom use. The European Journal of Contraception & Reproductive Health Care13(2), pp.114-122.

Schick, V., Herbenick, D., Reece, M., Sanders, S.A., Dodge, B., Middlestadt, S.E. and Fortenberry, J.D., 2010. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. The journal of sexual medicine7, pp.315-329.

Uchendu, O.C., Adeyera, O. and Owoaje, E.T., 2019. Awareness and utilization of female condoms among street youths in Ibadan, an urban setting in South-West Nigeria. The Pan African Medical Journal33.

Valente, P.K., Mantell, J.E., Masvawure, T.B., Tocco, J.U., Restar, A.J., Gichangi, P., Chabeda, S.V., Lafort, Y. and Sandfort, T.G., 2020. "I Couldn't Afford to Resist": Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya. AIDS and behavior24(3), pp.925-937.

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Yosef, T. and Nigussie, T., 2020. Behavioral profiles and attitude toward condom use among college students in Southwest Ethiopia. BioMed Research International2020.

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