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Condom use: Is it the answer to the HIV pandemic in Zimbabwe and Africa at large
Jephiter Tsamwi
March 06, 2013

Sometime last year, the debate on whether condoms should be given to school children made headlines but surprisingly the topic died without tangible and conclusive results. Well, for many it seem as if the issue is a mater for the archive, or a tired story to talk about in the press today. But after attending one public discussion on condom use in Zimbabwe in Harare this week, I could see the conflicting realities between what people think about the whole idea of condom use in the country and the actuality of the HIV horrible pandemic and endemic statistics. Indeed the debate on condom use is still as fresh as it was in the past.

Whether it is right or wrong to ensure availability of condoms in schools or not, will not be much of a concern in this piece. But within the discussions, there goes another dimension to the discourse which has never been awarded the adequate discussion time that it deserves. What I am talking about here is a simple yet though invoking question that we can conveniently put it like: Is condom use in Zimbabwe promoting promiscuity or serving lives?

Condoms have been widely embraced in developing countries perhaps more than they have been in the very countries where they are manufactured. At surface level, we can simply agree that the reason why condoms are imported in large quantities into the country correlates with the specific realities of the HIV pandemic. In other words the perceived risk by the people encourages them to use condoms. Yes, the commercialisation of condoms is something that we cannot deny, yet so far as painful as it is, that HIV is a serious threat to development in developing countries is our lived reality. According to UNAIDS, an estimated 5 million new HIV/AIDS infections occurred in sub-Saharan Africa in 2003. At the same time, World Health Organization (WHO), say 40.3 million people now live with HIV infections with two-thirds of them in sub-Saharan Africa. An HIV free generation remains a pipeline dream considering the latest statistics that we have. But before we get much into that, it is better to start by unpacking the following issue

Are condoms the solution to HIV in Zimbabwe?

To believe that the “triple C” concept will lead us to the land of Canaan is perhaps indicative of personified simplicity and naivety in its spectacular fashion. Correct and Consistent use of Condoms does work and for sure it can do us the tricks and produce the results that will put a smile in all and sundry. It is the practicability of this simple yet technical aspect that seems almost impossible in the African setting.

HIV prevalence is a gendered phenomenon characterized by marked inequalities between women and men. Further, it is a challenge whose causes go beyond limitless promiscuity and multi-sexual partners. Attitudes, perceptions, socio-economic relations within different intergroup like between men and women all feed into the seriousness of the challenge. This means condoms are not an end in themselves if other critical factors are not addressed.

Pessimistic as she sounds, British investigative journalist Sue Ellin Browder argues that condoms have never been shown to reduce HIV infection rates and AIDS deaths in general-population epidemics like those in sub-Saharan Africa. Accordingly, it is a paradox that the more condoms are sent to Africa, the more widespread the disease has become.

In South Africa, which has strongly promoted condoms as the best way to prevent AIDS, the number of free condoms distributed to the public rose rapidly between 1994 and 1998, from 6 million to 198 million. Including those sold, the total number of condoms distributed in South Africa during 1998 was nearly 210 million. However, statistics released by South Africa’s government in 2005 revealed that death rates skyrocketed from an average of 870 deaths a day in 1997 to 1,370 deaths a day in 2002-a 57 per cent increase while deaths of individuals ages 15 to 49 more than doubled!

Coming closer home, the Zimbabwe Demographic Health Survey (2011) reveals high prevalence rate within the age group that have been proved by research to be the highest users of condoms. For instance, the survey reveals that for women HIV prevalence increases from 4 per cent among those aged 15-19 to a peak of 29% in the 30-34 and 35-39 age groups before slightly declining to 23% among women aged 45-49.

With this sad reality, where then is the problem, yet we know condoms have been scientifically tested and proven that they can reduce the risk of HIV transmission by more than 94%. Let’s consider the following issues.

Use of condoms as sign of a deep rooted identity crisis

Zimbabwe can be argued to be a Christian country; and the latest population census can prove that. I, myself, am a devoted Christian and part of the doctrines within the holy bible that defines righteousness is the principle of one man, one wife. To the believers, sex before marriage and adultery are sins in the eyes of the Lord. In a country full of Christians, why then is HIV prevalence sky rocketing yet it is public knowledge that multiple and concurrent sexual partnerships within the populace is the major driving factor. It shows we really don’t have a clear stand point of who we are and what we want. The same Christians have a tendency of despising condom use, yet it’s the solution that can serve their lives in their unholy harlotry acts which they practice right in church, hiding behind the hymn book.

Secondly, we have a traditional value system that had its own parameters, dos and don’ts when it comes to sexuality. In the words of renowned Culture critique Pathisa Nyathi, the African parent has lost his/her child. Lost in that the very system and values that sustained us as Africans for decades failed to triumph in the vicious war against foreign encroaching systems that knocked down what used to be our pride. It was sexuality education without use of condoms. It was a system that promoted patriarchy but without social anarchy. A system that promoted polygamy but the marriages would last, family valued, sex sanctified, and cultured. Well gone are the days.

Analysts say Africa’s position gives it an excellent vantage position for self-reflection. Whether condoms are what will serve us or not is a question that needs to be critically analysed today. Of notable interest is that Arab nations, states that remained resolute in defending their culture and systems, are almost HIV free sections of the world. Never mind the statistics that made world news in 2012 that HIV prevalence re-doubled in these nations. We all know power dynamics and relations between those who were saying it and the alleged victims. But that’s a topic for another day. Where then do we stand as Africans, and as Zimbabweans to be specific? Globalisation is real and it is a threat to an otherwise value system that might have had been the solution to the pandemic that has no cure.

Daniel Yaw Fiaveh, a health researcher would ask; how can Africans strive toward a healthy balance between the positive elements of their own culture and those of other non-African cultures without losing a healthy attitude towards their own culture?

Wrong Attitudes and Perception have cost us a fortune.

Winston Churchil once said, “Attitude is one little thing that makes a big difference” After all, was it not Mahatma Gandhi whom in his wisdom taught us “Keep your thoughts positive because your thoughts become your words. Keep your words positive your words become your behaviour. Keep your behaviour positive because your behaviour becomes your habits. Keep your habits positive become your habits become your values, and your values become your destiny”. Do we have this kind of an attitude when it comes to condom use?

Studies that have been done have proven that both men and women have negative perceptions about the male or female condom. They have a retrogressive mentality that tells them condoms have no space in the matrimonial homes or in steady relationships. Couples feel if a partner suggests the idea of condomising, it is a sign of lack of trust. Men are very frequent users of condoms but they only do so when they hook up commercial sex workers in the streets. The assumption is that the wife at home is clean and safe and condom use is not but a waste of time, but only gullible individuals would live guided by this deathly assumption.

A study by Kpoti Kitissou “HIV Infection and Condom Use in Sub-Saharan Africa” reveals yet another dimension to attitudes and perception problems when it comes to condom use. He says condoms offer protection but do not warrant individuals a permit to be reckless. This is where the argument that “condoms are promoting promiscuity and not serving lives” comes on board. Kitissou argues that even though condoms are highly effective in reducing chances of HIV infection, that sense of feeling safer makes individuals extreme risk takers doing activities that may lead to HIV infection. If it is the case, then the whole idea of promoting condom use need careful scrutiny.

Coming back to the old debate of whether condoms should be availed to high schools or not, it would be good if as a nation we stop to act upon assumptions. That school kids are engaging sex remain an invalid fact unless a thorough and valid research has been done. Yes the media, especially social networks have exposed children to gratuitous content that subjects and tempts children to engage in risk behaviour but says who? It would be a lie to say that back in the days pornographic materials were not there and children were not exposed. It will be naïve to believe that System Tazvida’s Simoko music was not tempting but that did not warrant the need for availability of condoms in schools.

Personally, I believe availing condoms is not an end in itself. It is our attitudes and perceptions that tell us not to speak about sex within the family set up, worse to discuss about proper condom use that has cost us. Availing condoms should go simultaneously with sexuality education so that In the end, condoms will not promote promiscuity but offer protection against the backdrop of an engendered and cultured society that seems not so much ready to empress the dictates of changing times. This brings me to the next aspect

Religion and Culture: Enemy or Foe in the Discourse?

Culture has been well documented as one factor whose practices are accelerating the spread of HIV. But such theories need to be revised. For instance I don’t remember when was the last time I heard of a case of wife inheritance, kuzvarira and other practices that have been the scapegoat for long time. The problem does not lie exactly in those aspects. Rather that culture that defines a perfect wife as the one who is submissive is what need to be addressed. Females find it hard to negotiate, let alone initiative sex with their partners. But we have the female condom in the equation which UNIFEM confirms can reduce chances of HIV transmission by 90%.

Dominique Meekers and Kerry Richter in their study Factors Associated with Female Condom use in Zimbabwe argue that when used correctly, the female condom is as effective as the male condom in reducing HIV transmission and can be inserted hours before intercourse making it less likely than the male condom to reduce sexual spontaneity. But again, the set back is that culture has made men to believe that dry sex is the way to go. Albeit improvements that have been made for the female condom to be more comfortable to both partners, its acceptability levels within the society remains low. Instead of using it, women are found using unmentionable herbs that risk them to cervical cancer all in the effort to keep their privates dry to satisfy their wrongly cultured husbands and partners. This goes back to the gender imbalances between men and women in which sex have been viewed to be an act of meeting the gratifications of the penetrator.

Social and gender constructs limit the voice of women when it comes to sex and relationship. Masculine identities suppress women’s sexual freedom, and with men blessed with the material and resource power, subordination on the part of women is almost inevitable. Negotiating for safe sex, and in particular negotiating for condom use guarantees women of utmost failure. Patriarchal men will not listen to their plea.

Communication and couple dynamics are yet another set of important determinants. Due to the nature of our culture, women usually do not have a say in how, where, when and what time they can make love with their partners. At the end of the day, condoms seem not to be producing the proper results that they are supposed to in the quest to end the rapid and vicious spread of the pandemic.

Way forward and possible recommendations

First of all, if condoms are truly meant to serve lives, can somebody explain to me why carex condoms are going for 2 United States Dollars in our shops? The idea of commercialising the would be life serving products should be put to an end. Reliable, strong and effective condoms should not be made a reserve for the few who can afford. These are the products that should be given for free and government through the responsible ministries should lead in this drive.

Working with the students in tertiary institutions, I am very much aware that $2 may sound cheaper for many but for a student in our universities, very few can afford that but the painful reality is that they will not stop engaging in sex. Remember Nesidai and Ng’ang’a study at a Kenyan university where they discovered that 62 5% of the students had sexual intercourse within their first year at college! If it is the case with a university in Kenya, what more at Midlands State University, just to give an example?

Apart from that, condom distribution is far from being the true remedy unless proper education on the use of the condoms is done. By 2011, Population Service International (PSI) was marketing more than 45 million male condoms and just over one million female condoms. However, the statistics available seem to be fragmented and based on distribution rather than actual consumption. How they are consumed is perhaps another important element that needs careful investigation to avoid compromising their effectiveness to users.

Acceptability levels of the condoms, especially the female condom can only be improved when people’s attitudes and perception are changed. At society level, people need more education and orientation to enhance their appreciation of the condoms. A clear message that condom use is not a substitute for promiscuity need to be emphasised. As much as we want to advocate for the condom use, so should we emphasise on the one man, one wife concept. As Nomathemba Chiwoneso Chandiwana argues, HIV prevention programmes in this population should focus on delaying sexual debut, increasing perceived risk of HIV infection, encouraging partner communication, making condoms more easily accessible to young men and addressing gender equalities. Those organisations working around this area, SAYWHAT, PSI, SAFAIDS, NAC, ZNFPC and others, you have a lot of work to do.

Before I conclude my long piece, it would be important to remind you dear reader that condom use indeed does not offer a magic bullet kind of result. A classic demonstration to this is given by Sue Ellin Browder. She says: “Let’s assume that condoms are 85 percent effective (the most commonly accepted scientific finding). It means that if 100 people have sex with HIV-infected partners and they never use condoms, seven of the 100 will become infected within a year. If they always use condoms, one in 100 people will become infected. This looks impressive at first glance. But applied to a population of 10 million couples having sex for three years, we’re talking about approximately 300,000 new cases of HIV/AIDS. And that’s assuming perfect condom use, which doesn’t happen in broad populations in real life.”

Condomise my dear reader, it works, but don’t exaggerate your safety. Be responsible, sticking to one uninfected partner is the best.

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