Leddy, A., Chakravarty, D., Dladla, S., et al. AIDS Care (September 2015), e-publication ahead of print.
This study examined the relationship between couple-level sexual communication self-efficacy (SCSE) and consistent condom use, adjusting for the male partner’s endorsement of hegemonic masculine norms (HMNs). HMNs, which value male “toughness,” virility, and dominance over women, are believed to play a key role in the heterosexual HIV epidemic in South Africa. Couples SCSE, defined as a couple’s confidence in their ability to communicate about sexual risk reduction, could be a key leverage point for HIV prevention interventions for this high-risk group. The authors interviewed 163 sexually active heterosexual couples to collect information on demographics, relationship dynamics, and sexual activity. Analysis showed that the odds that couples used condoms were lower when male partners reported moderate to high endorsement of HMNs, compared to couples whose male partner reported low endorsement of HMNs. Additionally, couples with higher levels of SCSE, and those who participated in couple HIV testing and counseling, had increased odds of consistent condom use. Mutual knowledge of joint serostatus and relationship duration were not significantly associated with condom use. The authors concluded that future interventions should focus on promoting gender-equitable norms while also equipping couples with the tools for improving SCSE and fostering partners’ ability to work together to achieve improved sexual and reproductive health outcomes.