African Journal for Physical, Health Education, Recreation and Dance

(AJPHERD) October 2015 (Supplement 1:1), pp. 11-21.

The use of male condoms amongst female and male third year
undergraduate students at a rural university in South Africa
K. NEL, S.A. RANKOANA2 AND S. GOVENDER3
Departments of Psychology1, 3, Sociology & Anthropology2, University of Limpopo, Private Bag x
1106, Sovenga 0727, South Africa.
E-mail: Kathryn.Nel@ul.ac.za

Abstract
A quantitative study using a cross-sectional survey design was conducted to determine the factors
affecting the use of male condoms amongst male and female third year undergraduate students at
a rural university in South Africa. A protocol based on several short standardised questionnaires
was used. Demographic questions (sex and age) and an open ended question were added to give a
more holistic element to the research. Two hundred (200) questionnaires were handed out and
one hundred and ten (110) were correctly filled in and returned. Data were analysed using
descriptive statistics and Thematic Content Analysis (TCA). It was concluded that although
knowledge relating to male condom use was good, and the majority of respondents understood
how to use one, it did not mean they used male condoms consistently. Qualitative results gleaned
from the open-ended question revealed that male condoms are seen as untrustworthy and are
viewed as culturally inappropriate as they are not, out of Africa. Qualitative results also
suggest that patriarchal norms affect the use of male condoms.

Keywords: HIV/AIDS, contraception, prevention, patriarchy, taboo.

How to cite this article:
Nel, K., Rankoana, S.A. & Govender, S. (2015). The use of male condoms amongst female and
male third year undergraduate students at a rural university in South Africa. African Journal for
Physical, Health Education, Recreation and Dance, Supplement 1:1 (October), 11-21.

Introduction
Globally, the number of people living with HIV rose from around 8 million in
1990 to 35 million at the end of 2013 (WHO, 2013). Of the 35 million people
affected 24.7 million are found in sub-Saharan Africa, making it the most
affected region in the world (UNAIDS, 2013). In South Africa alone, an
estimated 6.3 million people were living with HIV/AIDS in 2013, the highest
number of people reported in any country. In the same year, it was estimated that
200.000 South Africans died of AIDS-related illnesses. This reflects the large
number of lives that the country has lost to the pandemic over the last three
decades (UNAIDS, 2013).The most effective prevention against sexually
transmitted infections (STIs) and HIV infection at present, is the male condom
(WHO, 2013), or total sexual abstinence.

12 Nel, Rankoana and Govender

There are cultural barriers associated with the use of birth control in many parts
of the world. The following studies, although using different scales and research
questions had results which support this statement. Many of these barriers relate
to male patriarchy and dominance in sexual matters for instance, the male in
traditional societies dictates the use of condoms (Nqojane, Nel, Tebele & Vezi,
2012). The authors note that females also find it embarrassing to discuss condom
use, have a lack of knowledge about the effectiveness of condom use in
preventing pregnancy, HIV and other sexually transmitted infections (STIs).
Beatty, Wheeler and Gaiter (2004) also report that there are culturally specific
stigmas related to condom use.
Bassey, Bassey, Ntuk, Smart and Akpan (2011), in a study of gender differences
in attitudes to condom use amongst secondary school students in Nigeria,
reported that much literature states that the majority of teenagers all over the
world are sexually active. As a result of this, the risk of contracting STIs and
HIV/AIDS is high amongst this group. In the Nigerian study, researchers found
that a total of 87 (24.2%) male and 114 (21.9%) female students were having
unsafe sex. The authors concluded that many secondary school students in
Nigeria do not consistently practice safe sex and are at risk of STIs and
unwanted pregnancies.
Peltzer (2000), in his study of factors affecting condom use amongst South
African university students, found that more than half of the respondents (57%)
had good knowledge about condoms prior to their first sexual encounter,
however, less than twenty percent (20%) of these reported using a condom the
first time they had sex. Eighty five percent (85%) of the respondents reported
having a sexual encounter during the month they participated in the study.
However, less than half of these reported to using condoms.
Later research by Lin, Chu and Lin (2007), related to condom use amongst
tertiary students in Taiwan identified four factors, which they suggest
significantly predict condom use amongst students. These factors are (1) having
previous sexual partners; (2) attitudes towards condom use; (3) self-confidence
and maturity of the individual and (4) peer attitudes towards condom use. Their
research concluded that students who had higher numbers of sexual partners had
lower self-confidence and more negative attitudes towards condom use. They
also reported that peers with negative attitudes towards condom use tended to
influence their friends with regard to not using condoms.
Cultural norms also play a role in peoples attitudes towards condom use (Polat
& Baser, 2011). The authors, in their study of Turkish male university students
knowledge and attitudes towards condom use, argue that there are important
differences between females and males regarding sexuality in Turkey. Females
are not allowed to talk about sexuality at all in many parts of the country whereas

The use of male condoms amongst female and male third year students 13
males can talk about sex openly. This creates risks for females who are unable
obtain accurate facts pertaining to issues of sexuality from their families, friends
or health professionals. The researchers found that nearly half of the male
respondents used condoms inconsistently and did not use other contraception
methods. It was noted that Turkey is a patriarchal society which leads men to
believe that they should have power over females, particularly in the sexual
arena. Males, in the research generally, had negative attitudes about the use of
condoms which, the researchers concluded put both male and female university
students at risk of HIV, STIs and unplanned pregnancies. Patriarchy, according
to Shivambu (2014) is a paradigm which results in the control of family,
organisations and governments by men. Fundamentally, it is linked to the fact
that men have a disproportionate amount of power in the world, as compared to
women, which is particularly true in traditional cultures which are the norm in
Africa.
According to Manuel (2005), in her study of obstacles to condom use among
secondary school students in Maputo city, Mozambique a key factor hindering
students use of condoms was gender inequality. This is linked to patriarchy in
that there is a widespread cultural acceptance that men have the power to decide
on all matters relating to sexuality. Young women are expected to be obedient,
and preferably be virgins before marriage, so that they are receptive to male
power and discipline. The researcher suggested that there is a belief amongst
young people in Mozambique that it is unnecessary to use condoms in
relationships that are underpinned by love and trust. It is posited that this belief
puts young people at risk of contracting STIs, HIV/AIDS and/or becoming
pregnant.
Eliakimu (2009), also noted that some African cultures still believe that condoms
are a part of a Western plot to control population size, kill women and generally
promote promiscuity and lack of morality amongst Africans, thus encouraging
instability (which allows cultures outside the continent to exert control over
mineral resources, for example). In addition to factors associated with condom
use, cultural norms affecting condom use have been pointed out for instance,
definitions of sex (ejaculate into a woman or to receive a mans sperm) which are
fundamentally patriarchal. Other factors that impede condom use are the notion
that flesh-to-flesh sex encourages intimacy and trust (using a condom implies
that a partner may be HIV positive or that ones own sexual behaviour is risky)
and the need to have children to further male lineage.
The use of male condoms is investigated in the present study as they are used
more frequently than female condoms. Research has indicated that, although the
female condom is an adequate alternative to the male condom, reluctance to use
it is associated with its difficult insertion (Artza, Demanda, Pulley, Posner &
Macaluso, 2002).

14 Nel, Rankoana and Govender

Methodology
The study used a quantitative approach utilising a cross sectional survey design,
which takes place at a specific moment in time, thus was appropriate for use in
investigating the research question. A qualitative element was added to the study
by the use of an open-ended question which is consistent with triangulation of
data.
Participants
The population under investigation was all third year undergraduate students at
rural university in Limpopo Province South Africa. The study used a purposive
sample. The sample was composed of third year psychology students.
Psychology students were used as it was convenient for the researchers. This
sample was considered appropriate as the majority of third year (senior) students
have lived both on and off campus with no caregiver/parental supervision for
some years and, as such, many were likely to have had sexual experience
(Nqojane et al., 2012). At the time of the study there were 460 students in the
third year psychology class. It was determined that twenty percent (20%) of the
class would provide an appropriate sample, thus 200 questionnaires were handed
out because of an expected high attrition rate (non-return of questionnaires).
Data collection
The questionnaire was handed out during the last 20 minutes of a 3rd year
psychology class. The questionnaires took approximately fifteen (15) to twenty
(20) minutes to fill in. The researchers gave instructions to respondents and
informed them of the reason for the research and ethics and confidentiality
pertaining to the study. This was also repeated in a consent form, attached to the
questionnaire, which respondents signed. Two hundred questionnaires were
handed out and 110 questionnaires received back which is a reasonable response
rate (55%).
Data Collection Instrument Questionnaires
The scales that were used, to make up the survey protocol were made up of freefor-use by the Centre for Community Health at the University of California
(CHIPTS, 2012). At the top of the protocol it was indicated that references to
condoms meant male condoms not female condoms.
The Condom Use Self-Efficacy Scale (CUSES) was utilised for the survey. The
scale contains 28 items (Brafford & Beck 1991), later up-dated by Brien,
Thombs, Mahoney and Wallnau (1994). The Condom Use Self-Efficacy scale
(CUSES) has four subscales: Mechanics (items 1, 27, 14, 22): putting a condom

The use of male condoms amongst female and male third year students 15
on self or other; Partner Disapproval (items 9, 10, 16, 17, 18): use of a condom
with a partners approval; Assertive (items 4, 5, 6): ability to persuade partner to
use a condom; Intoxicants (items 24, 25, 28): ability to use condoms while under
the influence. The scale has been used in studies using different ethnic groups
and in different social contexts and was developed specifically for tertiary
education students of mixed ethnic groups (some of whom were not first
language English speakers) in the United States of America (Brien et al., 1994).
It was thus seen as appropriate for use in a South African multi-cultural context.
Validity in studies using questionnaires relates to the degree to which the
questions provide a factual measure of what they are intended to measure
(Neuman, 2000). The scale is standardised and validated thus it measures what it
is designed to.
According to Brien et al. (1994), the scale has high levels of reliability on the
entire scale, test-re-test reliability and on internal consistency for subscales:
Internal consistency: Cronbach alpha (entire scale) = 0.91: Test-retest reliability
(two-week) = 0.81: Internal consistency for subscales: Mechanics: Cronbach
alpha = 0.78 Partners Disapproval: Cronbach alpha = 0.81Assertive: Cronbach
alpha = 0.80 and Intoxicants: Cronbach alpha = 0.82. These results are supported
by earlier research by Brafford and Beck (1991). Other threats to reliability and
validity occur through administrator bias when for instance; a researcher gives
clues to how he or she would like a question answered (Neuman, 2000).
Awareness and insight of the researchers into this fact lends objectivity to the
research process. Response bias is more pronounced with self-completed
questionnaires, since non-response is not a random process. This is partially
controlled, as although the questionnaire is self-report in nature, respondents will
be asked to fill it in at the end of a lecture period which is likely to improve
response rates.
The research does not make use of a random sample (drawn from a normally
distributed population), as a result of this parametric statistics cannot be used and
hypotheses cannot be tested. As non-parametric statistics were used in the study
a chi-square test was utilised to find if there is a statistical association between
specific variables (Curwin & Slater, 2005). In this case, to see if there were any
statistically significant differences between male and female respondents
responses with regard to male condom use. The study propositions are as
follows:
x
x

The majority of third year students participating in the research are aware
of the mechanics of condom use (how to use condoms properly.
There will be some significant differences between male and female
students regarding their reported knowledge about male condom use.

16 Nel, Rankoana and Govender

Data analysis
Data were analysed using descriptive statistics and the chi-square test was used
to look for trends in terms of the study propositions. Descriptive statistics were
used as they give a broad picture of the data under consideration making it easy
to interpret and understand (Neuman, 2000). The qualitative data gleaned from
the open-ended question were analysed using Thematic Content Analysis (TCA)
which uses a systematic process for assigning codes to words within the text,
which are later put into categories and then themes (Terre Blanche, Durrheim &
Painter, 2009). Thematic Content Analysis (TCA) allows themes to emerge
naturally out of data elicited from open-ended questions, thus was appropriate
for use in the study. The researchers familiarised themselves with the data and
then generated initial codes. After this they searched for meaning and themes
which were then reviewed until consistent patterns emerged. At each step of the
procedure researchers reflected on the process. As it was not possible to verify
meaning the researchers used each other as sounding boards, to ensure that the
themes reflected the original meaning as closely as possible (Braun & Clarke,
2009). The open ended question used in the study was: Please tell us how you
feel about male condoms and male condom use? The question was broad
therefore it allowed respondents to give a range of answers.
Ethical issues
Respondents were informed of the reason for the research and given relevant
information. They signed a consent form which indicated that they did not have
to participate in the study if they did not want to. As respondents were not
required to give their names or student numbers they were assured of full
confidentiality. The respondents were also informed that if they felt
uncomfortable or distressed after filling in the protocol they could approach one
of the researchers who would refer them to an appropriate professional. Consent
for the study was given through the Department of Psychology Research
Committee in 2012.
Results and Discussion
Demographic results indicated that the highest response rate came from
respondents aged from nineteen to twenty-three years (71.82%), followed by
respondents aged twenty-four to twenty-eight years (24.55%) and lastly,
respondents aged twenty-nine to thirty-five years (3.64%). It was found that
there were more female respondents (56.36%) as compared to male respondents
43.64% (SD = 3.69). Some respondents were older than the majority of third
year students at tertiary institutions in South Africa. This can be accounted for by
evidence which suggests that many Black students study later than other groups
in the country, due to lack of funds, as many have to work first (Banyini, 2014).

The use of male condoms amongst female and male third year students 17
The proposition that, the majority of third year students participating in the
research are aware of the mechanics of condom use (how to use condoms
properly), is upheld by the majority of quantitative research results. A summary
of these results indicates that the majority of research respondents (86.5%)
reported to have a good knowledge (that is they are very aware of how to use
condoms) regarding the mechanics of male condom use. A chi-square test was
used to see if there was a significant difference between the male and female
groups, (marked effects are significant if p =0.0500, used for all the chi-square
tests). In this case p = 0.057, df=2, chi-square= 1.36) which implies that there is
no statistically significant difference between male and female respondents in
terms of ability to put condoms on. However, respondents answers to an item
which measured the confidence of respondents in using male condoms
successfully in any situation noted that 4% of females and 1% of males were not
confident they could do this. A proportion of female (5%) and male (3.5%)
respondents were undecided about their ability to put condoms on (self or their
respective partners) quickly. This could imply that if they were to find
themselves in a situation where they had sex on the spur of the moment male
condom use might not be successful and unprotected intercourse might follow.
This is probably a contributing factor to non-condom usage. A chi-square test
was used, in this case p = 0.491; df=2, chi-square = 1.42, which suggests that
there is no statistically significant difference between male and female
respondents in terms of their ability to put condoms on quickly.
The majority of research respondents reported to being confident in their ability
to purchase condoms without feeling embarrassed (80%). However, of the
remaining respondents females (15%) and males (5%) still found purchasing
condoms embarrassing. A possible explanation for this is that the HIV/AIDS and
condom use campaigns, which are held on campus and in other media, have been
persuasive in the sense that they have taken away the fear and embarrassment
that respondents may have felt when purchasing condoms. However, this
statement is purely supposition and needs further investigation. A chi-square test
was used (p = 0.135; df=2, chi-square= 4.00) to see if there was any statistically
significant differences between male and female respondents in terms of feeling
embarrassed when buying male condoms, results indicate there were none.
Moreover, a substantial number of female respondents (60%) felt confident that
they could remember to carry a condom with them should they need one as
compared to fifty five (55%) of the male sample. This may be because they are
more susceptible to rape trauma, which is again an inference and, as such, needs
further investigation. There were no significant differences between males and
females in terms of remembering to carry a condom should they need one (chisquare=1.01; df=2; p=0.605). It was also reported that 92% of female
respondents were confident that they could suggest using a condom with a new
partner as compared to 80% of the male sample. A chi-square test (p = 0.135;

18 Nel, Rankoana and Govender

df=2, chi-square= 4.00), indicated no significant difference between males and
females in this regard. This indicates that females in the sample are generally
assertive and probably able to speak openly about sexual issues. On the other
hand, almost half (46%) of the total respondents did not feel comfortable in
suggesting using male condoms. No statistically significant difference was found
between the male and female groups on this item (p = 0.559, df=2, chi-square
1.16). This is supported by findings in the qualitative data. It is possible that
female respondents may experience cognitive dissonance in terms of what they
report and their actual behaviours. In the open-ended question they reported that
they have challenges discussing condom usage with their partners because they
feared that their partners would think that they had a disease or were cheating,
which also relates to the issue of trust amongst sexual partners.
Thirty percent (30%) of the respondents, both male (22%) and female (8%), were
not sure if they (or their partners), could maintain an erection while using a male
condom. It is evident that this percentage of male and female respondents are
likely to become anxious because of not being able to maintain (or their partner
retain) an erection when using a male condom. No significant differences were
found between male and female responses to this item (chi-square=1.32; df=2;
p=0.517). Fifty percent (50%) of female research respondents reported to not
being afraid to suggest using a condom to their partners, even if they were not
sure of how their partners would respond as compared to 45% of the male
respondents. This implies that these female and male respondents are well aware
of the consequences of having unprotected sex. However, the reverse could be
true for the other 50% of the female sample and 55% of the male sample. No
significant differences were found between male and female responses to this
item (chi-square=0.92; df=2; p=0.631).
Seventy two percent (72%) of female respondents reported to being confident
that they would remember to use a condom even after they had been drinking, or
using drugs, as compared to 50% of the male sample. No significant differences
were found between male and female responses to this item (chi-square=1.01;
df=2; p=0.605). The aforementioned results do not support findings from other
studies which posit that alcohol and substance abuse reduce inhibitions, making
people more prone to taking risks, such as unsafe sex (Mogotsi, 2011).
A total of 82 research respondents (75%) reported to being comfortable
discussing condom use (50 females and 32 males) and to being confident that
they could suggest using a condom with a new partner (even if the new partners
may think they had an STI). Forty one percent (41%) of respondents felt
confident that they could have protected sex even though their partners might
disapprove. However, the majority did not feel as confident (59%). No
significant differences between male and female responses were found on this
item (chi-square=2.20; df=2; p=0.333).

The use of male condoms amongst female and male third year students 19
Only a few research respondents thought they would be able to incorporate
putting a condom on themselves or their partners during foreplay (5% females
and 2% males). The majority were undecided or did not think they would be able
to do this. This suggests that the majority of the respondents were unsure if they
could maintain foreplay when putting on male condoms; this infers they would
not use a condom when having sex. On this item no significant differences in
responses were found between the male and female groups (chi-square=2.38;
df=2; p=0.304). Conversely, 24% of the respondents (15% female and 9%
males) were confident that they could use a condom with their partners without
breaking the mood, (no significant differences were found between males and
females on this item chi square=1.76; df=2; p=0.415). This suggests that only a
minority of the sample felt that having intercourse, when using a male condom
would not interfere with sexual pleasure. Many of the male research respondents
(82%) strongly agreed and (60%) of females strongly agreed with this item,
meaning that the majority of males and females were not confident that they
could still obtain pleasure when having protected sex. No significant differences
were found between male and female responses to this item (chi-square=1.97;
df=2; p=0.274). The proposition, there will be some significant differences
between male and female students regarding their reported knowledge about
condom use, was not upheld as none were found.
A review and systematic reading of the data elicited two themes from the openended questions. 1) Culturally specific stigmas associated with condom use
respondents reported that condoms were not appropriate for use in the African
culture and reported that they felt this is something that other places overseas
had brought to the continent and it was to prevent the population from having
babies, and they were not out of Africa. Female respondents also stated that
males do not want us to wear condoms because they will say we are cheating or
ill. 2). Not trustworthy respondents felt that condoms were not trustworthy
and even if they were used they felt they would still get AIDS or get
pregnant. Several respondents said that people put holes in condoms to make
sure we get ill. This probably is a leftover from the first government roll-out of
condoms in South Africa in which condoms were stapled to letters (often
through the condom). This error was attended to rapidly but it seems to have
become something of an urban legend through the following decades. The theme
also links to female respondents not trusting, males in terms of their supposed
intended condom use, they say they will use condoms but dont.
Conclusion
It is clear from the results that cultural and gender stereotypes related to
patriarchy play a role in the factors affecting male condom use amongst
undergraduate students because of the existing paradigm of patriarchy in the
country. Results indicate that most of the sample understands the importance of

20 Nel, Rankoana and Govender

using male condoms, this is not however, reflected in all their reported, and very
likely actual, sexual behaviour. The overall results indicate that most of the
respondents do not have problems (mechanical use) with how to use a male
condom, but this does not necessarily ensure that they use a condom
consistently. Qualitative results reveal that condoms are viewed as not
trustworthy and urban legends prevail (myths about putting holes in condoms). It
also reveals that culturally, male condoms are not seen as appropriate with one
respondent noted they are not out of Africa. The implications of this research
are that male condoms are still not consistently used by male and female
undergraduate students in this sample. Although study results cannot be
generalised, because of the sampling technique, it is very likely that this is the
case in similar universities in the country. Students will thus be prone to sexually
transmitted infections (STIs) including HIV and unwanted pregnancies. The
study recommends ongoing research (both qualitative and quantitative) in
university settings around the country relating to cultural taboos, patriarchy and
the use of male condoms.
Acknowledgement
The authors would like to thank the 2013 Honours in Psychology class for their
contribution to the research.
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