Consistent condom use among Botswana’s female population and associated factors

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Abstract
Background: Botswana is one of the countries severely impacted by the HIV/AIDS pandemic. Despite an extensive HIV prevention campaign, the incidence of HIV, particularly among women, remains high. Condoms play a significant role in preventing new HIV infections, although men and women do not consistently use them. Objective: The study assessed the individual, relationship and community factors associated with consistent condom use among women in Botswana. Design: A cross-sectional study using secondary data drawn from a national survey on Gender-Based Violence Indicators in 2012. Methods: The primary survey sampled 639 women, aged 18 years and older, using a multistage procedure. The final sample size for the secondary analysis included a total of 480 women who were sexually experienced and had reported using condoms with their male partners. Multivariate logistic regression analysis was employed to assess the association between consistent condom use and the explanatory variables. The multivariate logistic regression adjusted for cluster/community random effects. Results: About 43% of the women used condoms consistently in the past year. Consistent condom use was more likely among women who were employed in the past year (adjusted odds ratio = 1.77; 95% confidence interval = 1.25-2.50). While, women who lived with their partners (adjusted odds ratio = 0.46; 95% confidence interval = 0.28–0.74), had non-Christian beliefs (adjusted odds ratio = 0.52; 95% confidence interval = 0.29–0.92), perceived that their partners would be angry if they ask to use a condom (adjusted odds ratio = 0.19; 95% confidence interval = 0.06–0.58) and perceived that their community says women need their husband’s permission to do paid work (adjusted odds ratio = 0.56; 95% confidence interval = 0.38–0.83) were less likely to use condoms consistently. Conclusion: Consistent condom use among Botswana’s female population is suboptimal. Consistent condom use was higher among women with employment, and lower among women who lived with their partners, had non-Christian beliefs, feared their partners’ reaction upon asking for condom use and held inequitable community gender beliefs. To enhance women’s consistent use of condoms, friendly condom use information, female economic empowerment strategies and programmes that involve religious leaders and promote progressive and healthy masculine practices in Sexual Reproductive Health/HIV interventions should be considered.

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