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

Aine Aventin, Sarah L. Gordon, Christina A . Laurenzi, Stephan Rabie, Mark Tomlinson, Maria Lohan, Jackie Stewart, Allen Thurston, Lynne Lohfeld, G.J. Melendez-Torres, Moroesi Makhetha, Yeukai Chideya, Sarah Skeen

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Abstract

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.
Original languageEnglish
Article number1228
JournalBMC Public Health
Volume21
DOIs
Publication statusPublished - 26 Jun 2021

Bibliographical note

Funding Information:
This work was supported by Department for the Economy Northern Ireland under grant number DfE_ GCRF_19/1920.

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • Adolescent health
  • Adolescents
  • Condom use
  • Sexual and reproductive health
  • Southern Africa
  • Systematic review

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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