Condom use in sexual exchange relationships among young single adults in Ghana

Abstract

This article discusses some personal and situational factors which hinder the use of condoms among young single adults ages 18 to 25 years engaged in sexual exchange relationships in a Ghanaian town. Based on focus group discussions and in-depth interviews, this article highlights some key impediments often not adequately discussed in the discourse on condom use but considered vital in any attempt to increase condom use and ultimately reduce HIV transmission. The includes the dilemma facing women who want to use condoms for HIV prevention in premarital sexual exchange relationships (quite different from prostitution) contracted with material gain in mind. Women may face the risk of losing material benefits from sexual exchange relationships if the man is unwilling to use condoms. It is recommended that HIV health educators must increase the involvement of young single adults in exploring these and situational impediments and together design interventions to improve condom use.

PIP: Focus group discussions and in-depth interviews conducted in Cape Coast, Ghana, revealed significant obstacles to condom use among single women 18-25 years of age. Most female respondents were self-employed small-scale traders with low incomes, while male participants tended to be clerks or fishermen. In this society, men are considered the source of economic and physical power and in a position to demand sexual favors. Material recompense (e.g., money, food, or clothing) for premarital sex is standard practice outside the commercial sex work establishment and women often switch rapidly from relationship to relationship in search of a more materially rewarding arrangement. Such behavior is condoned--often encouraged--by young women's mothers. Condom use is rare and associated with infidelity. Thus, Ghanaian women face the dilemma of choosing between economic survival and unsafe sex. Since men perceive condoms as reducing sexual sensitivity, they are unlikely to remain with a partner who insists on condom use. Moreover, sexual relationships are embedded in an atmosphere of fear of violence. If women are to insist on condom use, they must believe the risk of HIV infection is not adequately compensated by the material gains received from the sexual encounter. It is recommended that community-level HIV preventive interventions target men with messages about the importance of trying condom use. Ultimately, however, reconstruction of gender-based power relationships and improvements in women's economic status are essential to reduce women's dependence on sexual networking.