Condoms: The REAL Excuses
After COVID-19, we don’t want to go back to normal. We want a new normal where there are “no excuses” to not protect your future – and that starts with your sex life.
Back in 2021, almost half of young people we surveyed said they did not consider using a condom every time they have sex.
As we launch our new brand partnership with condom company Sex Brand, we want to understand “the excuses” young people have for not using a condom. Understanding these excuses help inform our work to address the barriers young people face in using condoms.
In August 2022, together with our partner Reproductive Health Uganda (RHU), we undertook a participatory assessment of young people’s attitudes to condoms. We set out to answer pressing questions about young people’s perception of condoms, condom purchasing and attitudes on consent and pleasure. Nearly 200 young people, aged 16 – 30 years old took part across Uganda, expressing their insights and opinions when it comes to condoms. Through focus-group discussions with 60 young people, and a participatory survey of 140 respondents conducted with the help of our Outreach Tablets, young people gave us an exclusive insight into the many reasons to use and not use a condom.
KEY FINDING #1
Knowledge of condoms’ triple protection benefits does not motivate young people
to consistently use a condom.
Young people we surveyed widely understood the triple protection benefits of condoms. 9 out of 10 respondents had no problem identifying protection against HIV was a top reason to use a condom. While this comes as no surprise, as condoms have long been promoted as an essential tool in the fight to end HIV. Since the 1980s, generations of young people in Uganda were immersed in abstinence-only sex education - or the ABC approach “Abstinence, Be Faithful, use a Condom” as a key way of addressing HIV transmission.
Not surprisingly, more than half of young people we spoke to underscored the importance of condoms’ triple protection benefits in preventing HIV and STI transmission and preventing unintended pregnancies. While young people widely understood the health benefits of condoms, this did not translate into consistent use of condoms when having sex.
In Kampala, peer educator Bira shared her wise condom advice to young people in her neighbourhood. Bira is steadfast that consenting sexual partners must consider the impact of unprotected sex. “Think about HIV or an unintended pregnancy,” warns Bira. “Better to use a condom and be on the safe side.” Bira encourages young women to always have a condom on hand, as it is equally a young women’s responsibility to have safe sex as it is her male partner’s.
But the truth is: young people are simply not using condoms every time they have sex. A large majority of young people underscored that sex without a condom was indeed “a big deal.” Despite this sentiment, 38% of young people reported having unprotected sex in the past six months. And this is in line with national figures that suggests less than 44% of sexually active young women aged 15 - 19 years old currently use condoms, according to the Government of Uganda data.
So, why are young people put off by using condoms?
KEY FINDING #2
Young people are concerned about condoms’ social stigma.
Many young people expressed that condoms were a sensitive subject matter to discuss with their partners - let alone their teachers, parents and health professionals. 2 in 5 respondents reported feeling some negative emotion when talking about condoms with their partner, with many avoiding the topic entirely. Even when in a committed long-term relationship, young people would rather not talk about condoms with their sexual partners. Yet, many expressed that if their sexual partner suggested using a condom, it would make them feel like their partner cared for them.
Prevailing social and cultural attitudes about condoms deter young people from using a condom. Condoms can be associated with sex workers or transactional sex. When questioned, some young people expressed their worry that simply carrying a condom was an indicator of ‘sleeping around.’ Many didn’t want to give their partner the wrong impression about their sexual past. Young women were impacted a commonly held belief that women who carry condoms are immoral.
Embarrassment is directly linked to purchasing behaviour when it comes to condoms. While 20% of young people we surveyed said they were just too embarrassed to buy condoms, peer educators believed this number could be much higher. Young people in our Focus Group discussions expressed embarrassment as a top barrier preventing them from buying condoms. When asked what it would take to walk into a shop and buy a condom, one young people shouted “Courage!” much to the agreement of his peers.
Peer educator Mack distributes free condoms at his university’s halls of residence - mostly to young men. He restocks the condoms banks that often seem to disappear overnight. “It takes a lot of confidence to walk into a shop and buy a condom,” says Mack. While condoms are available at supermarkets and pharmacies, many of Mack’s peers are just too embarrassed to buy a condom.
While condoms are distributed across supermarkets, pharmacies there are even free dispensers in Uganda. Many feared what being judged by shopkeepers or even worse – seen by someone they know. Young people identified non-traditional distribution channels as an opportunity to take the embarrassment out of buying condoms, including distribution by peer educators in universities or at peer education sessions.
KEY FINDING #3
Young people have misconceptions about condoms and pleasure.
There is a strong perception among young people that condoms reduce sexual sensation and pleasure. In both individual interviews and focus groups, young people shared anecdotes of young men boasting of their need for extra-large condoms as a bravado for their masculinity. Many young people we interviewed were unaware that condom sizing can vary, and correct sizing has an impact on sensation and pleasure. Over 60% of respondents said condoms were an ‘unnatural’ sensation. Young people also had misconceptions about consent in sexual relationships. Half of young people believed consent could not be removed during sex.
“Many people say they use a condom to protect themselves from HIV but it can feel quite unnatural,” explains peer educator Harajah in Fort Portal. “Given the choice, many would rather not use a condom.” Harajah worries that many young people miss the point entirely that condoms can deepen and build trust in a relationship.
Sex-positivity in condom advertising was deemed important to young people. Across our research, young people praised marketing of pleasure-focused condom brands that used sexual innuendos in their messaging, branding and marketing. However, many young people warned that any messaging around condoms needed to be approached with some modesty given the prevailing social and cultural attitudes towards sex in Uganda.
Many young people underscored that more needed to be done to ensure young people understood the basics of condom use - how to remove packaging, apply and dispose. Young people identified specific knowledge gaps when it came to negotiating condom use with their partners, and the fact that consent can be removed if one partner refuses to use a condom.
KEY FINDING #4
Young people equate a condom’s quality with the condom’s brand.
Branding is a critical and an important factor in young people’s perception of quality and willingness to pay for quality. While young people praised a condom’s triple protection as critically important, 83% emphasised quality as the most important factor when picking a condom. An overwhelming 71% emphasised packaging as an important factor in deciding to buy a condom.
Most young people we talked to attributed a condom’s packaging and branding to having a higher quality compared to other brands. 62% of respondents reported that brand was important to them. Many young people perceived certain condom brands to have higher social value.
For many young people, their perception of quality was affected by branding. Most young people rated pleasure-focused condom brands as having the highest quality, with the readily available free condoms ranked to have the lowest quality. When asked why they felt these brands were superior, respondents underscored the condom’s branding, discrete packaging and colours.
In Mbarara, peer educator Fortunate will ask her peers: “If a condom falls out of your bag, what brand would you want it to be?” Fortunate explains that certain brands’ packaging is discrete and small. It can be embarrassing to be seen with a condom whose packaging is instantly recognisable.
Meanwhile, many young people were adamant that free condoms were inferior in quality, bemoaning the unattractive packaging. Many explained using popular pleasure brands were an immediate way to show their care and dedication to their sexual partner. If you love your girl enough, said one young man, make sure you buy a condom that shows how special she is.
KEY FINDING #5
Young people are willing to pay for branded condoms.
Young people we talked to do not mind spending a little bit more for quality condoms and brand names. Many expressed their willingness to pay for ‘higher quality’ condoms at a premium cost. Young people believed spending money on condoms demonstrates care and affection for your sexual partner. Buying condoms was explained as a cheap expense, with a high reward. Many expressed their unwillingness to pay for brands that are currently available for free and leaving these free condoms for those that need it most. Even for young people that readily use free condoms, there was an expressed willingness to pay for a condom that was perceived to have higher quality.
In Mbarara, peer educator Karim laughed that many young people do not want to be seen picking up a condom from the free condom dispenser. Despite occupying a prime location at the clinic, many young people wait for the darkness of night before daring to subtly pocket a free condom. “If you can afford it, leave the free condoms for those that need it most.”
Respondents rarely said the price of condoms was a barrier to condom use. For many, cost was a small factor in their decision to use a condom, with many prioritising quality, access and prevention of STIs and unintended pregnancy as ranking higher for reasons to use a condom. Most young people said UGX 2,000 (equivalent to US$0.50) for a pack of three condoms was an acceptable price point, in line with the cost of social sector condoms on the market in Uganda.
The findings of this survey will be used to help SafeHands and RHU support and measure behaviour change through our project Knowledge and Information on Safe Sex (KISS) and the promotion of our new partnership with Sex Brand.